GOP Governors Put GOP Senators in a Bind Over Medicaid
As Senate Republican leaders scramble to rework legislation to reform Obamacare, which stalled Tuesday in advance of a planned vote, others in their party are celebrating: namely, a handful of Republican governors who were among the powerful forces working against the bill.
Behind the scenes and in public, governors from states that expanded Medicaid coverage under the Affordable Care Act have been working to derail the Senate’s reform process, or at least redirect the chamber from reducing federal Medicaid contributions below expansion levels.
Their concerns have meant that wrangling the votes to pass a Senate health care bill has not merely involved winning over fence-sitting GOP senators, but their governors as well.
Sen. Dean Heller, a Nevada Republican who opposed the first draft of the bill, said in a tele-town hall after the legislation stalled Tuesday that he had been facilitating a dialogue between the White House and Nevada Gov. Brian Sandoval, a Republican who has opposed cuts to Medicaid.
On any subsequent versions of the bill, Heller said that Senate leaders would need “to make us an offer we can't refuse, me and the governor.”
And Heller isn’t the only one. Republican Sens. John McCain and Jeff Flake of Arizona, and Sen. Rob Portman of Ohio, have also had GOP governors whispering in their ears about Medicaid funding.
Ohio Gov. John Kasich said he has discussed the issue “a million times” with Portman, and “he knows exactly what my concerns are.” But so does the entire country: Kasich traveled to Washington on Tuesday in part to express his disapproval for the Senate bill to reporters.
One of his concerns, the 2016 presidential candidate said, was that Portman and other senators could be persuaded to support a Medicaid rollback in exchange for commitments to subsidize certain pet issues. “And I told him, ‘If they hand you a few billion on opiates, opioids, [in exchange for] repealing Medicaid expansion, that’s $4 billion a year,” Kasich added. “That’s like spitting in the ocean.”
After the bill stalled, Portman released a statement expressing his opposition to the doomed measure, citing his “concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic.”
Likewise, McCain said he has “been in constant communication” with Arizona Gov. Doug Ducey, a fellow Republican, regarding the health care bill.
“My own governor is extremely worried, because we’re a Medicaid expansion state and we would lose a whole lot of money, according to him,” McCain said. “And he’s the governor.”
Indeed, Ducey wrote a letter to McCain last week, even before the Senate legislation became public, outlining those and other concerns about a potential health care reform proposal, according to a copy of the letter provided to RCP by Ducey’s office. “Repeal is important,” Ducey wrote, “and the replacement must be carefully crafted to ensure that the rug is not pulled out from under people.”
Other GOP governors have attempted to leave their own mark on the process. Florida’s Rick Scott, whose state has not accepted the Medicaid expansion authorized by Obamacare, traveled to Washington on Tuesday, meeting with Senate Majority Leader Mitch McConnell and Vice President Mike Pence regarding the pending health care bill.
“I want to make sure that under a Medicaid plan we’re treated fairly,” Scott told Fox News regarding his visit. “We should get treated as well as any other state. No better, no worse.”
Complicating their balancing act further, the Trump administration and Senate Republicans have not only needed to weigh the concerns of Republican governors. Democratic governors in states that expanded Medicaid, too, have been pressuring their GOP senators to push back against proposed cuts.
Sen. Shelley Moore Capito, a West Virginia Republican, acknowledged this week in announcing her opposition to the Senate’s first draft that her state “has the largest Medicaid population in the country.”
“I recognize that many West Virginians rely on health coverage and access to substance abuse treatment because of my state’s decision to expand coverage through Medicaid,” said Capito in a statement Tuesday. In April, a letter from the office of Gov. Jim Justice warned Capitol and other West Virginia lawmakers that any Medicaid rollback “would create an unsustainable financial obligation for” their state.
Likewise, Sen. Cory Gardner, a Colorado Republican who chairs the National Republican Senatorial Committee, has gotten an earful from Gov. John Hickenlooper, a Democrat, who appeared with Kasich in a news conference Tuesday to oppose the Senate bill. Hickenlooper said he would “camp out on his doorstep” if it meant he could sway Gardner against backing the proposal.
Gardner “certainly knows, and other people have talked to him, how important this is to me,” Hickenlooper said. “I look at this as one of the bedrock issues that he is going to define himself on.”
But a Democratic elected official at odds with a Republican is nothing new. The most unusual and consequential dynamic has been among GOP senators who face competing pressures from conference leadership and their governors. Kasich acknowledged the conflict his advocacy has sparked — but he also defended it.
“No one should think that I have any joy in being able to work against the leadership of my own party on this legislation,” Kasich said. “But maybe [President Kennedy] said it best: Sometimes my party asks too much.”