Nevada Gov. Brian Sandoval may as well be the Senate’s 53rd Republican.
GOP leaders are trying to win over the popular moderate and outspoken Obamacare repeal critic, believing his strong influence over Sen. Dean Heller in the health care debate could get them one vote closer to victory,
Though other Republican governors have problems with the Senate bid to gut Obamacare and end Medicaid as an open-ended entitlement, Sandoval is thought to be the likeliest to flip a "no" vote to a "yes" to give Majority Leader Mitch McConnell the 50 votes he needs to pass a repeal plan.
“At the end of the day, it comes down to Sandoval,” one Republican aide said of Heller’s position.
Making the bill more generous could antagonize conservatives, who have been angling to put strict limits on how much the federal government spends on Medicaid each year. But it would get the attention of Republican senators who are sensitive to or taking cues directly from home state governors, who’d have to cut benefits or drop people in the reshaped health system.
The previously uncommitted Heller stunned many Republicans recently when he appeared next to Sandoval at a Las Vegas news conference and ripped the GOP’s draft repeal bill, even saying supporters’ claims that the bill would bring down premiums are a "lie." Sandoval was the first Republican governor to opt in to Obamacare’s Medicaid expansion in the fast-growing state, a move that netted more than 200,000 new enrollees.
“If you want my support … you gotta make sure the Republican governors that have expanded Medicaid sign off on it. I’ve been saying that for months,” Heller said. “Where is Gov. Sandoval? What does he think? How does he feel about the changes that are occurring?”
Republicans got the message: With Sandoval in, Heller could be had.
Sandoval’s office confirmed that Senate leadership has reached out to the Nevada governor, though a spokeswoman would not say what was discussed.
Observers believe their best chance to get his support is reworking the way the bill rolls back Obamacare’s Medicaid expansion and puts the entire program on a budget, changes that would reduce federal Medicaid spending by $772 billion over a decade, according to the CBO. Sandoval has been critical of certain parts of the Affordable Care Act and says the law needs fixing, but he has railed against the GOP’s plans for Medicaid because of what they would mean for his state budget and its uninsured rate.
“Their gamble could pay off,” one GOP operative said of Heller and Sandoval, who have known each other since the 1990s, when they both served in the Nevada Legislature. “They’re going to shape what [the bill] looks like.”
Heller is viewed as perhaps the third staunchest Republican holdout, behind moderate Sen. Susan Collins and conservative Rand Paul, according to GOP sources. Without one of the trio, repeal could stop in its tracks.
A Heller spokeswoman said the senator has had several meetings with Vice President Mike Pence, Senate leadership and the Trump administration to propose improvements to the bill.
"For him, it’s not about getting to a ‘yes,’ it’s about improving the legislation to lower costs for Nevada families and business while protecting Nevada’s most vulnerable,” Heller spokeswoman Megan Taylor said.
Among Republican governors, John Kasich of Ohio, Doug Ducey of Arizona and Asa Hutchinson of Arkansas have also said the current version of the Senate bill is unworkable because of its Medicaid provisions. Their states are home to undecided Sens. Rob Portman of Ohio, Jeff Flake and John McCain of Arizona and Tom Cotton of Arkansas.
But none has staked his vote more on the perspective of his governor than Heller, the most vulnerable Republican incumbent going into the 2018 midterm elections.
A total of 31 states and the District of Columbia expanded Medicaid under Obamacare, with 16 currently led by Republicans. Sandoval, who was elected in 2010 and is term-limited next year, has repeatedly touted the benefits of expanding Medicaid for his state.
More than 200,000 people obtained coverage in Nevada under Medicaid expansion, and 90,000 more have private insurance through the state’s Obamacare exchange. Nevada’s uninsured rate for nonelderly adults fell nearly 15 percentage points over three years, going from 29 percent in 2013 to 14.5 percent last year.
“Today, Nevada’s in a much better place than it was six years ago, four years ago, even two years ago,” Sandoval said at the news conference with Heller. “And I want to keep that momentum going, because your health is the base of everything.”