Governors to Lobby Senators on Health Bill Over Recess

The Senate GOP’s delay in voting on Obamacare repeal will give governors more time to push for changes.

Arizona Gov. Doug Ducey
AP Photo/Angie Wang
Erin Durkin
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Erin Durkin
June 30, 2017, 1:06 p.m.

Sen­ate GOP lead­ers hope to have a vote on their Obama­care-re­peal bill shortly after re­turn­ing from re­cess. In the mean­time, sen­at­ors will be back home with some es­pe­cially im­port­ant con­stitu­ents—gov­ernors—who have their own ideas about how health care re­form should be go­ing.

The delay on the vote will al­low the Sen­ate plans to mar­in­ate among the 50 dif­fer­ent gov­ernors, many of whom are ex­tremely un­happy with the ini­tial Sen­ate product and are press­ing law­makers for changes. Sen­ate Re­pub­lic­ans had con­tin­ued ne­go­ti­ations to hope­fully reach a deal be­fore they left town.

Be­fore Sen­ate Re­pub­lic­ans delayed their vote, a bi­par­tis­an group of gov­ernors had asked them to do ex­actly that.

“On be­half of the Na­tion­al Gov­ernors As­so­ci­ation, we urge you to give states suf­fi­cient time to re­view the le­gis­la­tion be­fore pro­ceed­ing, so that the full im­pact of the le­gis­la­tion may be un­der­stood and ex­plained to the Amer­ic­an people,” wrote Govs. Terry McAul­iffe of Vir­gin­ia and Charlie Baker of Mas­sachu­setts.

But al­low­ing more time to de­term­ine what their ideas mean for each state could make the work for sen­at­ors harder. Sen. John Mc­Cain of Ari­zona, who said he is in con­stant con­tact with Gov. Doug Ducey, has said he wants cer­tain changes to be con­sidered or else lead­er­ship could risk los­ing his sup­port.

“[Ducey] knows what he wants for the state of Ari­zona, and that’s what we’re com­mu­nic­at­ing about, and that’s why I have three amend­ments that were de­signed by him that when we get on the floor that I’d like to have con­sidered and voted on. That has a lot to do with wheth­er I sup­port the bill or not,” said Mc­Cain.

Ac­cord­ing to Politico, Ducey had writ­ten Mc­Cain a let­ter out­lining his top con­cern with the Sen­ate health bill: Medi­caid. He com­plained that a three-year phase-out of the ex­pan­sion funds would not leave enough time to man­age the state’s budget and that the growth rate needs to ex­ceed med­ic­al in­fla­tion.

Flor­ida Gov. Rick Scott has also said that he wants to make sure his state, which did not ex­pand Medi­caid, gets fairly re­im­bursed for the pro­gram. Maine Gov. Paul LePage wrote to Sen. Susan Collins say­ing the block-grant op­tion does not provide enough flex­ib­il­ity to the states, al­though he sup­ports the dis­cour­age­ment of fur­ther Medi­caid ex­pan­sion.

Gov­ernors can be very in­flu­en­tial by sway­ing their sen­at­ors and col­lect­ively weigh­ing in, said former Utah Gov. Mike Leav­itt.

Many of the pro­posed re­forms for Medi­caid will be pushed out bey­ond the 2018 and 2020 elec­tion cycles. Start­ing in 2021 would be the gradu­al phase-down of the ex­pan­sion fund­ing, and the per-cap­ita spend­ing caps would be placed on the en­tire pro­gram start­ing in fisc­al year 2020. In 2025, the growth rate for those caps would be lowered to the gen­er­al in­fla­tion rate, which some law­makers have de­cried as be­ing too severe a cut to the pro­gram.

Leav­itt pre­dicted that push­ing the changes to Medi­caid off fur­ther would keep the door open to changes. “There will be plenty of time for this fight to oc­cur in 2021, 2022, and 2023,” he said.

But two Demo­crat­ic gov­ernors in red states com­plained that this in­tro­duces a level of un­cer­tainty. “They may want to try and push to get bey­ond one elec­tion cycle or an­oth­er, but I’ve got to do long-term plan­ning for this state as well, and the un­cer­tainty that this cre­ates is sig­ni­fic­ant,” Montana Gov. Steve Bul­lock said on a press call Wed­nes­day.

Louisi­ana Gov. John Bel Ed­wards ar­gued that the Sen­ate is ap­proach­ing its du­ties the wrong way. “I’ve ac­tu­ally had a few people tell me, ‘Well, they know it’s bad; they just figured there’s enough time between now and when it kicks in that they’ll get it fixed.’ That’s not a re­spons­ible way to le­gis­late on such im­port­ant mat­ters,” he said.

Trish Ri­ley, ex­ec­ut­ive dir­ect­or of the Na­tion­al Academy for State Health Policy, said there are broad con­cerns among the people she works with about the im­pact on budgets and the loss of rev­en­ue.

“If people lose cov­er­age, which the [Con­gres­sion­al Budget Of­fice] has been pretty clear will hap­pen, they turn to their loc­al gov­ern­ment,” Ri­ley said. “… They turn to their gov­ernor and ask for help.”

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