San­doval’s stance could kick legs out from un­der bill

The Washington Post Sunday - - POLITICS & THE NATION - sean.sul­li­van@wash­post.com dan.balz@wash­post.com

GOP’s strug­gles over health care this year.

The de­lay, how­ever, does not change the po­ten­tially cen­tral role for San­doval. More than any other Repub­li­can in the coun­try right now, the cen­trist gov­er­nor of Ne­vada could hold the power to sink or salvage the health-care bill that Se­nate GOP lead­ers had hoped might get a vote in the com­ing days.

Among the 32 state ex­ec­u­tives who at­tended the Na­tional Gov­er­nors As­so­ci­a­tion sum­mer meet­ing here this weekend, no one drew more at­ten­tion and in­ter­est than San­doval, a square-jawed 53-yearold with neatly parted dark hair, a made-for-TV smile and a po­lit­i­cal dis­po­si­tion that is the an­tithe­sis of Pres­i­dent Trump.

All weekend, he has been be­sieged — by re­porters tak­ing his tem­per­a­ture and by ad­min­is­tra­tion of­fi­cials, in­clud­ing Vice Pres­i­dent Pence, try­ing to per­suade him that the Se­nate bill would not hurt his Ne­vada con­stituents de­spite its deep fed­eral spend­ing cuts to Med­i­caid.

So far, he isn’t buy­ing what the ad­min­is­tra­tion is sell­ing. “I’m no dif­fer­ent than I was,” San­doval told re­porters af­ter a gov­er­nors-only meet­ing Satur­day morning with Health and Hu­man Ser­vices Sec­re­tary Tom Price and Seema Verma, ad­min­is­tra­tor of the Cen­ter for Medi­care and Med­i­caid Ser­vices. San­doval said he is likely to come to a fi­nal de­ci­sion “early next week.”

The Trump ad­min­is­tra­tion mounted a full-court ef­fort here in Providence, rec­og­niz­ing the re­sis­tance not only by San­doval but other Repub­li­can gov­er­nors who are po­ten­tially in­flu­en­tial with their state’s sen­a­tors. De­spite a heavy pub­lic and pri­vate ef­fort, how­ever, the ad­min­is­tra­tion ap­peared to have changed no minds — and may even have hard­ened some of the op­po­si­tion.

One mo­ment in par­tic­u­lar drew pri­vate crit­i­cism from gov­er­nors of both par­ties — when Pence openly tar­geted Ohio Gov. John Ka­sich (R), a vo­cif­er­ous op­po­nent of the Repub­li­can health-care pro­posal, seem­ing to in­cor­rectly link the length of dis­abled wait­ing lists to the ex­pan­sion of Med­i­caid.

A spokesman for the vice pres­i­dent said Satur­day evening that Pence was not try­ing to link the two but was only talk­ing about need for re­forms.

At a meet­ing Satur­day morning with gov­er­nors, Price and Verma sought to dis­credit other analy­ses show­ing po­ten­tially dev­as­tat­ing con­se­quences for states un­der the Se­nate bill, in­clud­ing a yet-to-be re­leased analysis by the non­par­ti­san Con­gres­sional Bud­get Of­fice and an in­de­pen­dent analysis by the health-care firm Avalere, which was pre­sented at the meet­ing.

Other key Repub­li­can gov­er­nors also ex­pressed skep­ti­cism about the bill af­ter the closed-door gath­er­ing, high­light­ing the Trump ad­min­is­tra­tion’s strug­gles. “There’s still work to be done,” said Ari­zona Gov. Doug Ducey. Arkansas Gov. Asa Hutchin­son the­o­rized that the Se­nate bill “is prob­a­bly not the bill that’s ac­tu­ally go­ing to be voted on.”

Heller cited San­doval when he an­nounced his op­po­si­tion to an ear­lier ver­sion of the Se­nate bill. The two men and their staffs are in close con­tact an­a­lyz­ing the newer ver­sion.

San­doval, first elected in 2010, was the first Repub­li­can gov­er­nor in the na­tion to de­cide to ex­pand Med­i­caid un­der the Af­ford­able Care Act.

And he well rec­og­nizes the po­si­tion he holds in the freighted de­bate over the fu­ture of Oba­macare — and with it per­haps the fu­ture of the Repub­li­can Party. “Of course I am,” he replied when a re­porter asked him if he is feel­ing the weight of his po­si­tion. “That’s part of what be­ing a gov­er­nor is all about.”

“A lot of peo­ple’s lives and health and health care and qual­ity of life is in the bal­ance,” he added. “I’m a for­mer judge. I take in all the in­for­ma­tion, and then I make a de­ci­sion, and that’s what I’m do­ing now.”

The Se­nate Repub­li­can pro­posal would cut $772 bil­lion from Med­i­caid over the next decade and re­sult in 22 mil­lion fewer Amer­i­cans with in­sur­ance com­pared with current law, ac­cord­ing to a CBO as­sess­ment of an ear­lier ver­sion. An up­dated score is ex­pected as soon as Mon­day.

The Avalere study pre­sented Satur­day morning pro­jected fed­eral Med­i­caid fund­ing re­duc­tions in all 50 states, rang­ing from 27 per­cent to 39 per­cent by 2036. In Ne­vada, the study pro­jected a 37 per­cent re­duc­tion.

Ad­min­is­tra­tion of­fi­cials in­clud­ing Pence ar­gue that Med­i­caid is not sus­tain­able in the fu­ture and that what they are do­ing is sav­ing the pro­gram over the long run by rein­ing it in. They also ar­gue that no one stands to lose cov­er­age in the face of clear data sug­gest­ing oth­er­wise.

San­doval is not re­ly­ing on those ar­gu­ments. He said his team is run­ning its own num­bers back home. He said he has not spo­ken to Trump in the last few days. But he plans to speak to Heller on Sun­day or Mon­day.

The po­lit­i­cal pres­sure Trump can ap­ply on more con­ser­va­tive Repub­li­cans does not ap­ply as much to San­doval. He hails from a state where Trump lost, and he rose through the ranks in a dif­fer­ent wing of the Repub­li­can Party than the pres­i­dent.

Some Demo­cratic col­leagues who know San­doval well are deeply skep­ti­cal that he will sup­port the Se­nate bill. Vir­ginia Gov. Terry McAuliffe thinks there is “zero” chance that San­doval comes out in sup­port. Colorado Gov. John Hick­en­looper said San­doval, “as he al­ways does with ev­ery is­sue, asks the right ques­tions. He’s try­ing to do it for the right rea­sons.”

The prospect of vot­ing on the health-care bill in the com­ing days was cast into doubt late Satur­day when Sen. John McCain’s of­fice said he would be in Ari­zona this week re­cov­er­ing from surgery to re­move a blood clot from above his left eye.

“On the ad­vice of his doc­tors, Se­na­tor McCain will be re­cov­er­ing in Ari­zona next week,” said McCain (R-Ariz.) spokes­woman Julie Tar­allo.

Two Repub­li­can sen­a­tors — Rand Paul (Ky.) and Su­san Collins (Maine) — have said they do not in­tend to vote yes to pro­ceed to the bill. Along with all 48 sen­a­tors in the Demo­cratic cau­cus — and with­out McCain — that would be enough to block the bill from pro­ceed­ing to de­bate.

A McCon­nell spokesman did not im­me­di­ately re­spond to re­quest for com­ment on whether the Se­nate still planned to vote.

Sen. Thomas R. Carper (D-Del.), a for­mer gov­er­nor, said he spoke at the meet­ing about the need to “hit the pause but­ton” and re­set with a more de­lib­er­a­tive and in­clu­sive ap­proach to the health-care bill.

Wis­con­sin Gov. Scott Walker (R) said the Se­nate ef­fort re­minded him of the House en­deavor — which pro­ceeded in fits and starts be­fore ul­ti­mately pass­ing. He pre­dicted even­tual suc­cess in the Se­nate, though he de­clined to of­fer a time frame.

With­out San­doval, few be­lieve that is pos­si­ble. Asked whether the ad­min­is­tra­tion of­fi­cials changed any minds over the weekend, the Ne­vada gov­er­nor was blunt.

“Here? Likely not,” he said.

STEPHAN SAVOIA/AS­SO­CI­ATED PRESS

Ne­vada Gov. Brian San­doval (R), left, and Vir­ginia Gov. Terry McAuliffe (D) talk at the Na­tional Gov­er­nors As­so­ci­a­tion’s sum­mer meet­ing in Providence, R.I. San­doval was the first Repub­li­can gov­er­nor in the na­tion to de­cide to ex­pand Med­i­caid un­der the Af­ford­able Care Act.

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