Governors confronted President Donald Trump’s top health officials over the cost of the Republican health care push to their states in a tense, closed-door session here Saturday.
Vice President Mike Pence, Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Administrator Seema Verma made a frantic bid at the National Governors Association meeting Friday and Saturday to win over — or at least silence — skeptical GOP governors.
But their efforts left major questions unanswered, Republican and Democratic governors said.
And Pence’s speech Friday resulted in the vice president openly feuding with Ohio Gov. John Kasich, a Republican who didn’t attend the governors’ meeting.
Price and Verma had been dispatched to the meeting in Rhode Island to convince governors that their states could absorb the elimination of enhanced Medicaid funding for low-income adults who received coverage under the Affordable Care Act and the reduction of federal support for their overall Medicaid programs.
They urged governors to ignore Congressional Budget Office estimates that 15 million fewer people would be covered by Medicaid by 2026 and that $772 billion would be cut from the program, compared to current law, under a Senate Republican bill that would eliminate Obamacare’s expansion of the program.
Their argument: States would gain flexibility to overhaul their traditional Medicaid programs through block grants or per-enrollee caps, allowing them to save money that could be used to stave off losses of coverage.
But the closed-door session with Price and Verma on Saturday was “pretty atrocious,” said Connecticut Democratic Gov. Dan Malloy.
“They repeatedly pretended that the federal government saving hundreds of billions of dollars won’t translate to actual cuts,” he said. “I was told that I’ll innovate sufficiently to save them hundreds and hundreds of billions of dollars.”
Republicans also emerged from the meeting saying they remain concerned about the long-term financial fallout of the bill.
“I think there’s disagreement on the outcomes and what that means and whether that is manageable,” said Arkansas Gov. Asa Hutchinson, a Republican whose state expanded Medicaid.
“It is a huge challenge for us in terms of communicating what the future is going to be like to our health care providers,” Hutchinson told CNN after the meeting. “That is the challenge for governors — we’re on the front lines here. … It’s the long term that people want to know about.”
Another key governor, Nevada Republican Brian Sandoval, told reporters afterward that he remained concerned about the bill’s elimination of funding for Obamacare’s Medicaid expansion, which led 210,000 Nevadans to gain coverage. Nevada Republican Sen. Dean Heller has closely linked his vote to Sandoval’s position.
Malloy said he argued with Price and Verma when — after Verma had taken issue with the Congressional Budget Office forecasts of coverage losses — Price cited the CBO analysis to back up a separate point.
“They were incredibly inconsistent between themselves,” he said. “They support what they like from CBO, and they attack CBO. But at least the secretary was forced to admit that’s the only public generated analysis.”
Just before Price and Verma spoke Saturday morning, the consulting firm Avalere Health delivered a presentation that forecast cuts in federal Medicaid funding to the states of 27% to 36% by 2036 under the Senate legislation when compared to current law.
Some governors said that presentation left them less certain about the Trump administration’s claims that Medicaid funding would not decline.
“I think there’s still some confusion on numbers,” said Wyoming Gov. Matt Mead, a Republican. “And so, frankly, I wish we would have had more time this morning to ask questions. There’s still a lot of questions from Republicans and Democrats.”
Mead said there is a clear divide among GOP governors based on whether their states expanded Medicaid. Mead’s state did not. But he said he’s still struggling with a “state of flux” on Capitol Hill over health care.
At the center of the case Pence, Price and Verma made to governors was increased flexibility to make changes to their states’ Medicaid programs. Under the bills, states could opt to receive a lump sum of money — known as a block grant — to cover certain Medicaid recipients. They would receive more control over their programs in exchange.
The bill’s critics, however, say that cash-strapped states won’t be able to make up for the losses in federal funding even with the additional flexibility. States would be forced to cut enrollment, benefits or provider rates, they argue.
The Trump administration has pledged to aggressively grant states’ requests for waivers that would allow them to deviate from traditional Medicaid, and the House and Senate health care bills would give federal officials even further authority to grant those waivers, giving states additional freedom to craft their own programs using federal dollars.
That, Republican governors said, is good news. Hutchinson said Price and Verma gave governors “a number of new ideas that had not been considered before.”
Pence’s speech Friday drew a tepid reception from Republicans and Democrats in attendance.
He made a reference to Kasich, saying, “I suspect that he’s very troubled to know that in Ohio alone, nearly 60,000 disabled citizens are stuck on waiting lists, leaving them without the care they need for months or even years.”
That claim, though, is bogus, Kasich’s office said. The waiting lists are related to Medicaid’s home and community-based services and had nothing to do with Ohio’s decision to expand Medicaid under Obamacare.
“The claim is not accurate. It’s been fact checked twice,” Kasich’s communications department said on Twitter, linking to fact-checks from The Los Angeles Times and the Columbus Dispatch.
At the same time Price and Verma were attempting to win over governors, the White House was circulating a new op-ed in The Washington Post in which Trump aides Marc Short and Brian Blase argued that Americans and lawmakers should give “little weight” to CBO projections that millions would lose coverage under the Senate GOP bill.
“The CBO’s methodology, which favors mandates over choice and competition, is fundamentally flawed,” the two argued. “As a result, its past predictions regarding health-care legislation have not borne much resemblance to reality. Its prediction about the Senate bill is unlikely to fare much better.”
