Sandoval still skeptical about health bill after meeting with Pence
Nevada Gov. Brian Sandoval said he had a “very productive” meeting Friday with Vice President Mike Pence and other top leaders in the Trump Administration, but said he’s basically in the same position as he was before on the Senate health bill.
Sandoval had said Thursday that if the latest version of the bill was similar to its earlier iteration, “it would cause me great concern.” Pence is trying to sell Sandoval on the bill in an effort to gain support from Republican Sen. Dean Heller, who takes many of his cues on health policy from the governor.
“I had a lot of questions for them,” said Sandoval, who’s at the National Governors Association summer meeting in Rhode Island. “I expressed my concerns in terms of protecting the expansion population and then not seeing any interruption in our quality of life and of treatment.”
He also explained to Pence and the others that more than 70 percent of the newly eligible Medicaid population in Nevada uses the “managed care” model, in which a private insurer receives a set $370 per month per patient and tries to manage their use of services to control costs. Sandoval challenged the administrators to show that it could be done more cheaply, and how it would be different if those Medicaid patients were transferred to a health insurance exchange plan where they’d probably choose between the same insurers involved in managed care.
The governor said he hadn’t spoken to Heller on Friday — he’d been at back-to-back meetings and events during the conference in Providence — but said the dialogue with the administration would continue.
“They have offered to continue to work with us,” he said. “I’ve told them I’m going to keep an open mind because it’s the responsible thing to do to listen to them and see if they can answer our questions.”
On Twitter, Pence posted a photo of himself poring over a spreadsheet with Sandoval and Centers for Medicare and Medicaid Services Administrator Seema Verma.
Pence touts health bill in speech to governors
Sandoval met with Pence shortly after the vice president gave a speech urging governors to help the Trump Administration “rescue” the country from a “collapsing,” “imploding” Obamacare.
Pence, who just a year ago was a governor himself and had expanded Medicaid in Indiana under the Affordable Care Act (ACA). In his speech, Trump’s deputy extolled the divisive health bill as a way to refocus Medicaid on the neediest, give governors more freedom to customize health care to their state and make the program sustainable.
“As Medicaid grows, there’s less and less money for schools and roads and public safety,” he said. “The truth is that for a long time, Medicaid has been a broken system that’s been fundamentally unsustainable and the expansion that occurred under Obamacare only made the system worse.”
The vice president made the case that too many able-bodied people are on the rolls, crowding the system and pushing people with disabilities onto waiting lists. Medicaid’s growth has gobbled up resources and the program needed to be put on a budget for the first time in its history, Pence said.
He also told of people who approached him with tears in their eyes to say they couldn’t use their Obamacare coverage at providers in their county, and said one woman was debating whether to pay her insurance premiums or buy Christmas presents for her children.
Pence faces an uphill battle persuading leaders like Sandoval, who seldom talk about the bill creating flexibility and more often fret about the 22 million people who were projected to lose health insurance by 2026 under the immediately preceding version of the bill. Sandoval was the first Republican governor to expand Medicaid eligibility under ACA and has stood by that decision, saying it’s improved the quality of life for hundreds of thousands more Nevadans and stabilized hospitals’ financials.
Earlier in the day, Sandoval expressed doubts that a $70 billion allocation to stabilize insurance exchanges would make up for a loss of Medicaid funding of about $700 billion, saying “anybody can do the rudimentary math on that.”
“It was the speech that I expected,” Sandoval said. “He believes deeply that it’s the right thing to do. I admire him for that and I respect him for that. But there were some things in our private meeting that we were able to talk about that he didn’t know about Nevada.”
Democrats from Nevada have talked in far more strident terms about the legislation, which faces a tough path to get enough votes. Sen. Catherine Cortez Masto called the Senate proposal “a tragedy,” and Rep. Dina Titus sent a letter to Sandoval urging him to “stand your ground” against the “disastrous” bill in his conversations with Trump Administration officials.
But while Medicaid would no longer fund all the people meet who certain criteria, Pence touted the freedom the bill would give states through either a per-capita capped money allotment or a block grant.
“Know that the Senate health bill gives states the freedom to redesign their health care markets,” he told the governors. “And most significantly under this legislation, states in this country will have an unprecedented level of flexibility to reform Medicaid and bring better coverage, better care and better outcomes to the most vulnerable in their states.”
Pence argued that after his expansion of Medicaid, his state attempted to customize health care in Indiana. But the federal government took two years to respond and then rejected most of their proposal anyway.
“President Trump is dedicated to getting the federal government out of your way,” he said. “Our administration wants you to innovate.”
His message drew limited applause from the crowd, which included Democratic governors who had excoriated the Senate health bill at a press conference earlier in the day.
“Either you want to destroy Medicaid in America or you want to stand with people’s health care,” Connecticut Gov Dan Molloy said at an event organized by the Democratic Governors Association.
But Pence got a heartier reaction at one point — when he pointed out that the bill included $45 billion more to fight the opioid abuse epidemic. The governors association has been active on the issue and held a panel discussion on it on Thursday.
“Passing this bill is a vital step to help those that are suffering,” he said, “and put our entire nation on a road to healing.”