PROVIDENCE, R.I. — The Trump administration tried to reassure governors Saturday that funding in the Senate’s Obamacare repeal bill and administrative flexibility would prevent people from losing coverage if the legislation becomes law.
Governors of both parties were briefed on the Senate bill, which would dismantle major parts of Obamacare and cap federal Medicaid payments to states, during a closed-door session with HHS Secretary Tom Price and CMS Administrator Seema Verma.
A handful of GOP governors after the roughly two-hour meeting said they were reassured by the administration’s description of flexibility HHS and CMS has at its disposal. But other Republicans and Democrats did not appear to be swayed and were no closer to supporting the Senate legislation.
“We as governors are the closest representatives to the people,” said Nevada Gov. Brian Sandoval, a Republican who has been the target of a full-court press from the White House to support the Senate bill, in hopes that it will bring along uncommitted Republican Sen. Dean Heller.
“I am struggling to validate the numbers that are being presented to me by the administration versus what I’m hearing from independent [experts], what I’ll likely hear from the CBO, what I’m hearing from back home,” said Sandoval, who chuckled when asked whether any minds had changed, saying "likely not."
The Senate bill unwinds enhanced federal funding for Obamacare’s Medicaid expansion and sets spending caps for overall Medicaid funding and strict limits on their growth, something that has alarmed many GOP and Democratic governors.
“From my perspective I’m no more comfortable about what this next bill is,” said Montana Democratic Gov. Steve Bullock. “Flexibility without funding is a meaningless thing.”
Administration officials on Saturday also disputed initial estimates from the nonpartisan Congressional Budget Office that 22 million people would lose coverage under the Senate bill by 2026, including roughly 15 million from Medicaid, according to individuals in the room. CBO early next week is expected to release an updated estimate on the latest version of the Senate bill, which bolstered private insurance subsidies for low-income people and added billions of dollars for opioid addiction treatment, among other changes.
Verma discussed how the Senate bill’s tax credits for private insurance and billions of dollars in funding to stabilize insurance markets would reduce coverage losses, in addition to a variety of waivers that CMS can grant to states. The state stability fund in the bill now has $182 billion.
The administration is arguing that everyone will still have coverage, just through the private insurance market, Sandoval said.
“I think one of the takeaways is that the way this problem is going to get solved is the governors innovating at the state level,” said North Dakota Gov. Doug Burgum, a Republican. “Any time that you move towards more state flexibility in a market that’s this dynamic, then that’s a step in the right direction.”
Verma has made similar arguments about flexibility and the extra funding in the Senate bill to moderate Republican senators who are still on the fence about repeal, including Heller, West Virginia’ Shelley Moore Capito and Rob Portman of Ohio.
But governors were presented stark figures from independent experts showing how the Better Care Reconciliation Act would slash their federal Medicaid funds. States would see reductions ranging from 27 percent to 39 percent by 2036, according to estimates developed by consulting firm Avalere Health and obtained by POLITICO.
In total, the Senate bill would reduce federal Medicaid spending by $772 billion over a decade.
“I do acknowledge there’s additional flexibilities to the states. But at the end of the day it’s going to be the flexibility to cut people,” said Louisiana Gov. John Bel Edwards, a Democrat. “You’re either going to have fewer people covered, or the coverage you offer will be much less than is currently offered. I’m not interested in that.
Fifteen states would see their federal Medicaid funding decline by more than 35 percent by 2036, according to the Avalere projections. They include California, Nevada, Kentucky, Washington, North Dakota, Oregon and New Mexico. States that would see reductions between 30 and 35 percent include Colorado, Arizona, Utah, Ohio, Arkansas, Pennsylvania and Tennessee.
“One of the emphasis though is the flexibility grants to the states that really are not being factored in sufficiently. That was one of the main points of discussion,” said Arkansas Republican Gov. Asa Hutchinson.
But he still said he wanted to see the Senate bill “improved” so that the Medicaid funding reductions to states were not as large. The Avalere presentation estimated that Arkansas would see a 32 percent reduction in federal Medicaid funds by 2036.