CARSON CITY, Nev. (AP) — The pressure is on Republican senators —
from congressional leaders, conservative groups and impatient GOP
voters — to fulfill a seven-year-old promise to scrap much of
Democrat Barack Obama’s health care law. But back home,
Republican governors who have experienced some of the upside of
the law are warning their GOP senators to first, do no harm.
For these governors, the issue is less about delivering a triumph
to President Donald Trump and more about not blowing a hole in
state budgets and maintaining health care coverage for
constituents. In the critical next few weeks, some governors are
uniquely positioned to press home-state Republican senators who
could deny Majority Leader Mitch McConnell the votes he needs to
pass a Republican health care bill.
“We are the voice of reality,” Nevada GOP Gov. Brian Sandoval
told The Associated Press.
Sandoval said he has been in regular contact with Nevada
Republican Sen. Dean Heller to discuss the ramifications of the
evolving GOP plan. Heller, who faces a tough re-election next
year, has joined Sandoval in opposing the current measure.
For wary Republicans, the main concerns about the GOP plan are
rolling back premium subsidies that help people buy private
insurance policies and phasing out the expansion of Medicaid, the
federal-state insurance program for the poor, disabled and many
nursing home patients. In Nevada, more than 220,000 residents
have gained coverage through Medicaid expansion, 13,000 of them
“They set policy, but we’re the ones who have to develop the
budgets, develop the care, develop the plans, work directly with
the people,” Sandoval said. He said if money is reduced,
governors will be left to decide among unpopular choices: “Raise
a tax or limit coverage or change eligibility requirements” for
woman protests against the Republican healthcare bill in Utah on
Heller is listening.
“I cannot support a piece of legislation that takes insurance
away from tens of millions of Americans and tens of thousands of
Nevadans,” he said recently.
Ohio’s John Kasich has been one of the most outspoken GOP
governors in criticizing GOP proposals. That has increased
pressure on Ohio GOP Sen. Rob Portman, who announced his
opposition to the bill after McConnell abruptly postponed a vote.
“My concern all along has been, could low-income Ohioans get
access to the health care they need and more specifically, the
treatment for the opioid epidemic?” he told reporters this past
Portman said he has discussed with Kasich various financing
options that would ease any changes to Medicaid while not gutting
drug treatment programs. One McConnell proposal would be to
provide an additional $45 billion over a decade for states’ drug
In Arizona, GOP Gov. Doug Ducey has called Obama’s law “a
disaster” and stopped short of outright opposition to McConnell’s
version. But he has urged Republican Sens. Jeff Flake and John
McCain to shield states from extensive Medicaid cuts. The program
covers 1.9 million Arizonans, nearly 28 percent of all residents.
The expansion alone covers 400,000.
Both senators have yet to indicate how they’d vote on a GOP bill.
Alaska Gov. Bill Walker, an independent who identifies as a
conservative, has had regular contacts with the state’s two
Republican senators — Lisa Murkowski and Dan Sullivan — over what
the Republican health care overhaul will mean for his state.
Alaska has some of the highest health care costs and greatest
medical needs in the country.
Traditional Medicaid covers about a quarter of Alaska’s 740,000
residents, while the expansion benefits 34,000 more.
Murkowski has said she doesn’t have enough information to vote
for the GOP plan. She has opposed the elimination of federal
money for Planned Parenthood, a provision of the bill.
McConnell has little wiggle room. With 52 Republican senators,
just three defections leave him short of a majority. Democrats
are unified in opposition.
The Republican leader has said he plans to introduce yet another
version of the bill after Congress returns on Monday. But
McConnell also said that if he is unable to get 50 votes for the
GOP plan, he would try to shore up insurance markets, a
legislative step that would involve Democrats.
Press/Ross D. Franklin
In Nevada, Sandoval and Heller have a public service record that
has overlapped since 1994, when Sandoval won a seat in the Nevada
Legislature and then-Assemblyman Heller was elected to the
secretary of state’s office. Sharing a moderate approach in their
conservatism, they have a relationship going back decades.
“He trusts me to give him information,” the governor said, “and
he trusts me” for speaking up for people who have benefited from
the Medicaid expansion.
When scandal forced out Republican Sen. John Ensign in 2011,
Sandoval tapped then-Rep. Dean Heller to fill the Senate seat.
Asked whether he would consider endorsing one of Heller’s
challengers if the senator eventually voted to roll back
Medicaid, Sandoval laughed.
“No,” he said. “Absolutely not.”
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