A handful of GOP governors opposed to their party’s proposals to overhaul Medicaid could potentially kill Mitch McConnell’s effort to repeal Obamacare.
Nevada Gov. Brian Sandoval, a Republican moderate who has hammered the repeal efforts for months, helped to deliver Sen. Dean Heller to the “no” column Friday. He stood next to Heller in the governor’s conference room in Las Vegas as the Nevada Republican announced he could not vote for the Senate repeal plan as written.
“I cannot support a piece of legislation that takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans,” said Heller, becoming the fifth senator to go public with a threat to vote against the bill since it was unveiled. “It’s going to be very difficult to get me to a yes.”
Other GOP governors, including Ohio’s John Kasich and Arizona’s Doug Ducey, are pressing their own lawmakers — including Rob Portman (R-Ohio) and John McCain (R-Ariz.) — to oppose or alter provisions the state executives fear would cut billions in Medicaid funding to their budgets over the next decade.
Governors have no authority over their lawmakers, of course, and their sway is as much about personal relationships as it is about state politics. But even a handful of strongly opposed Republican governors could provide political cover for their senators to oppose the legislation.
And that could be a problem for McConnell, who can afford to lose only two of his 52 members to pass the bill, which could see a floor vote as soon as next week.
Kasich, for instance, whose state expanded Medicaid, has spearheaded much of the opposition to GOP plans to restructure Medicaid, but it is unclear yet whether he has persuaded Sen. Rob Portman, the state’s one GOP senator.
"Gov. Kasich is going to speak out every day until the vote is taken," said John Weaver, a Republican political strategist who advises Kasich. “What influence that has on Rob Portman? I have no idea."
Portman is among the moderates also being wooed by McConnell. A co-leader of a group of GOP senators from states that expanded Medicaid, the Ohio senator has sought a longer phase-out of that program and wants more money to address the opioid crisis since many substance abusers have gotten treatment through Medicaid. He has not said how he plans to vote.
Ducey, meanwhile, wrote a letter to McCain obtained by POLITICO expressing support for repealing Obamacare, which he called "a policy disaster," but outlining his objections to the Senate draft: He complained about a three-year phase-out of Medicaid expansion funding, saying he would not have enough time to plug holes in the state’s budget. He asked for more explicit Medicaid flexibility — and he said that federal funding for the program needs to grow at a rate exceeding that of medical inflation.
“Medicaid must be able to pay for the real-world costs of providing care,” Ducey wrote. Arizona’s Medicaid agency on Friday released an analysis that the draft Senate bill could cost the state roughly $7 billion between 2018 and 2026.
McCain, who has said he would consult Ducey and other state leaders, has not said how he will vote.
With only two days since the text of a bill written in secret was released publicly, most senators have declined to say how they will vote. But several say they are consulting with their governors and other state leaders before they make a decision.
After the release of the bill, Heller said he would share it with Sandoval to help determine whether it is good for his state. “As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not – I won’t,” he said in a statement.
Roughly 24 hours later, Heller stood alongside Sandoval announcing his opposition. “I think we can do better,” said Sandoval, a moderate who is term limited in 2018. “If you don’t have access to meaningful healthcare and you can’t get the care that you need, nothing else really matters.”
The issues for most Republican governors relate to how the GOP plan treats Medicaid, a federal-state program that provides health coverage to the poor, the elderly and the disabled — approximately 74 million in all. Sixteen red states expanded Medicaid under Obamacare.
The Senate bill would phase out that expansion over three years — a longer window than allowed for in the House legislation but one that moderates say isn’t long enough. It also proposes to eliminate Medicaid’s status as open-ended entitlement, a sweeping change that some argue could threaten care for tens of millions of children, pregnant women, the elderly and disabled individuals.
In addition, the plan would cap federal Medicaid funds to states based on the number and type of enrollees, with the funds growing in sync with medical inflation until 2025, after which they would drop to the lower rate of general inflation. That has caused alarm among many state officials in both parties, who say those types of spending reductions are not tenable.
Aware of the huge role that Medicaid plays in their states, most senators say they’re consulting with their colleagues back home.
"I have to tell you that I try to respect and respond to the elected leaders in my home state," McCain said Thursday during his weekly Facebook Live town hall. "In this particular case, because Arizona is a Medicaid-expansion state, it is even more important."
North Carolina Sen. Thom Tillis, whose state has a Democratic governor but a GOP-controlled state Legislature said he planned to be talking with state legislative leaders this weekend.
“As complex as it is, there are really only a handful of levels you need to look at and see how it affects your state,” he said.
Jennifer Haberkorn contributed reporting.