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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