PROVIDENCE, R.I. — With billions of federal dollars for their states on the line, the nation’s governors are watching closely as the Senate GOP bill to repeal and replace the Affordable Care Act stumbles toward a conclusion in Washington.
“It’s on everyone’s mind. It’s in every private conversation. There’s a high degree of anxiety,” said Rhode Island Democratic Gov. Gina Raimondo, the host of the summer meeting Friday and Saturday of the National Governors Association here. “They see it as an unfair shift of financial burden from the federal government to the states.”
Vice President Mike Pence, who has been leading the White House’ lobbying efforts while President Donald Trump is in France, addressed the governors Friday to sell the health care plan and meet privately with some of his party’s more skeptical state leaders.
Trump has made it clear he’s watching closely, tweeting early Friday morning that he’s waiting, “at my desk, pen in hand” to sign a health care bill.
At the top Pence’s list for courting is Republican Gov. Brian Sandoval of Nevada, the NGA co-chairman and a political moderate who is an outspoken opponent of the bill.
Both in public and in back rooms, seemingly everyone here is trying to buttonhole Sandoval into influencing —one way or the other — his fellow Nevada Republican, Sen. Dean Heller, who is seen as the one of the decisive vote on the Senate bill.
“Senator Heller and I are in constant conversation, and obviously he’s going to vote and make up his own mind,” Sandoval said. “But I’ve told him all along that I’m very worried.”
Heller is the most endangered Republican senator up for reelection in 2018 and has not yet said how he plans to vote on the Senate bill. Two GOP senators are already opposed to measure and Senate Majority Leader Mitch McConnell cannot afford to lose even one more vote.
Of particular interest to the governors is the Medicaid expansion. Obamacare incentivized states to dramatically expand access to the public health care program with the promise that federal government would foot much of the cost.
A majority of states took the deal and are now worried about losing the federal money they relied on to provide healthcare to millions of their residents. While most of those states are controlled by Democrats, some Republicans like Sandoval opted into the program as well.
Sandoval joined two other moderate GOP governors, John Kasich of Ohio and Charlie Baker of Massachusetts, in drafting a letter to McConnell last month criticizing the Republican approach to health care and calling for a bipartisan one instead.
In his speech, Pence did not beat around the bush about why he had come to Providence, devoting most of his remarks to a hard sales pitch for the GOP health care plan.
“President Trump and I believe the Senate bill is the right bill at the right time to begin the end of Obamacare and rescue the American people from this failed policy,” Pence said to fairly muted applause.
As the governors sat in white leather desk chairs arranged in diamond formation in front of the podium, Pence went on for 20 minutes, mixing statistics with personal anecdotes, leaning on his experience as a former governor vouch for the bill.
Pence expanded Medicaid as governor of Indiana, as Virginia Democratic Gov. Terry McAuliffe, the chairman of the NGA, reminded the audience in a backhanded compliment during his introduction of the vice president.
But Pence used that to his advantage.
“As a former governor who expanded Medicaid in our state, I understand and appreciate, as the president does, the concerns that many of you have,” Pence said. “The truth is, for a long time Medicaid’s been a broken system that’s been fundamentally unsustainable...This just can’t continue. That’s why the Senate health care bill for the first time in its history puts Medicaid over budget.”
Pence specifically addressed the concerns of Kasich, who was not present, and extended thanks Sandoval for his leadership in the NGA, but mentioned no other governors by name.
Meanwhile, even Democrats from conservative states felt comfortable slamming the latest version of the repeal plan.
The Senate health care bill is "trying to put lipstick on a pig, guess what, it’s still a pig,” said Montana Gov. Steve Bullock.
John Bel Edwards, the Democratic governor of Louisiana, called for a bipartisan approach to healthcare that leaves the Affordable Care Act largely in place.
“It is literally saving lives, it is saving money, it is making a real difference for working people in our state,” he said.
Republican Gov. Doug Ducey of Arizona said this week that the Senate bill “needs a lot of work.”
“I am talking with [Arizona GOP] Senators [Jeff] Flake and [John] McCain and I’m telling them what my opinion is, and I’m letting them know that I don’t want to see any Arizonan have the rug pulled out from underneath them,” he said in a radio interview.
Even some GOP governors from red states that have not expanded Medicaid are expressing concern.
“We can’t just have a significant cost shift to the states because that’s something we cannot shoulder,” Arkansas Gov. Asa Hutchinson said on MSNBC. “The new Senate bill made significant progress in a number of areas that we’ve requested, but there’s still a challenge in terms of cost-sharing with the states.”
However, other conservatives, like Kentucky GOP Gov. Matt Bevin, backed the Republican plan to repeal Obamacare.
“Something has to be done. I'm a big proponent above all else of having control given back to the states,” Bevin told reporters. “The reality is this was supposed to create more opportunity for people, but it’s had the exact opposite effect. We were very close to having half our counties with no provider.”