By Sean Sullivan and Dan Balz, The Washington Post
PROVIDENCE, R.I. — Brian Sandoval spent his Saturday morning 3,000 miles from home tucked away in a convention center ballroom where two top Trump administration officials tried to persuade him that everything would be okay under their plan to dramatically alter the nation’s health-care system.
As a result, the Republican Party’s seven-year quest to overhaul the Affordable Care Act remains at serious risk of hitting another wall next week.
More than any other Republican in the country right now, Sandoval, the centrist governor of Nevada, could hold the power to sink or salvage the health care bill Senate GOP leaders are hoping to pass in the coming days.
Sandoval’s voice is more influential than perhaps any other Republican governor here — largely because what he decides is widely expected to determine the vote of his home-state colleague, Sen. Dean Heller. Senate Majority Leader Mitch McConnell, R-Ky., has already lost two Republican votes. A third would be game over.
Among the 32 state executives who attended the National Governors Association summer meeting here this weekend, no one drew more attention and interest than Sandoval, a square-jawed, 53-year-old with neatly parted dark hair, a made-for-TV smile and a political disposition that is the antithesis of President Donald Trump.
All weekend, he has been besieged — by reporters taking his temperature and by administration officials, including Vice President Mike Pence, trying to persuade him that the Senate bill would not hurt his Nevada constituents despite its deep federal spending cuts to Medicaid.
So far, he isn’t buying what the administration is selling. “I’m no different than I was,” Sandoval said after a governors-only meeting Saturday morning with Health and Human Services Secretary Tom Price and Seema Verma, administrator of the Center for Medicare and Medicaid Services. He said he is likely to come to a final decision “early next week.”
The Trump administration mounted a full-court effort here in Providence, recognizing the resistance not only by Sandoval but other Republican governors who are potentially influential with their state’s senators. Despite a heavy public and private effort, however, the administration appeared to have changed no minds — and may even have hardened some of the opposition.
One moment in particular drew private criticism from governors of both parties — when Pence openly targeted Ohio Gov. John Kasich, a Republican who is a vociferous opponent of the GOP health care proposal, with inaccurate facts about Medicaid waiting lists for the disabled in Ohio.
At a meeting Saturday morning with governors, Price and Verma sought to discredit other analyses showing potentially devastating consequences for states under the Senate bill, including a yet-to-be released analysis by the nonpartisan Congressional Budget Office and an independent analysis by the health care firm Avalere, which was presented at the meeting.
Other key Republican governors also expressed skepticism about the bill after the closed-door gathering, highlighting the Trump administration’s struggles. “There’s still work to be done,” said Arizona Gov. Doug Ducey. Arkansas Gov. Asa Hutchinson theorized that the Senate bill “is probably not the bill that’s actually going to be voted on.”
Heller cited Sandoval when he announced his opposition to an earlier version of the Senate bill. The two men and their staffs are in close contact analyzing the newer version.
Sandoval, first elected in 2010, was the first Republican governor in the nation to decide to expand Medicaid under the Affordable Care Act. He sees some strong similarities between his current predicament and that one.
“We did a tremendous amount of due diligence leading up to that decision,” he said. “This is the identical process that I used leading up to making that decision.”
Sandoval well recognizes the position he holds in the freighted debate over the future of Obamacare — and with it perhaps the future of the Republican Party. “Of course I am,” he replied when asked him if he is feeling the weight of his position. “That’s part of what being a governor is all about.”
“A lot of people’s lives and health and health care and quality of life is in the balance,” he added. “I’m a former judge. I take in all the information and then I make a decision and that’s what I’m doing now.”
The Senate Republican proposal would cut $772 billion from Medicaid over the next decade and result in 22 million fewer Americans with insurance compared to current law, according to a CBO assessment of an earlier version. An updated score is expected as soon as Monday.
The Avalere study presented Saturday morning projected federal Medicaid funding reductions in all 50 states ranging from 27 percent to 39 percent by 2036. In Nevada, the study projected a 37 percent reduction.
Administration officials including Pence argue that Medicaid is not sustainable in the future and that what they are doing is saving the program over the long run by reining it in. They also argue that no one stands to lose coverage in the face of clear data suggesting otherwise.
Sandoval is not relying on those arguments. He said his team is running its own numbers back home. He said he has not spoken to Trump in the last few days. But he plans to speak to Heller on Sunday or Monday.
The political pressure Trump can apply on more conservative Republicans does not apply as much to Sandoval. He hails form a state where Trump lost, and he rose through the ranks in a different wing of the Republican Party than the president. In addition to more warmly embracing the ACA, he has championed comprehensive immigration reform, whereas Trump has espoused a hard-line posture against illegal immigrants.
Some Democratic colleagues who know Sandoval well are deeply skeptical that he will support the Senate bill. Virginia Gov. Terry McAuliffe thinks there is “zero” chance Sandoval comes out in support. Colorado Gov. John Hickenlooper said Sandoval, “as he always does with every issue, asks the right questions. He’s trying to do it for the right reasons.”
Even as the Trump officials made a hard sell for the partisan Senate bill here Saturday, others pushed for a more bipartisan approach that is gaining steam among a growing number of Republican and Democratic lawmakers who are increasingly looking beyond the current GOP push.
Sen. Thomas Carper, D-Del., a former governor, said he spoke at the meeting about the need to “hit the pause button” and reset with a more deliberative and inclusive approach to health care bill.
Outside the room, applause from the inside could be heard. Asked what it was for, Carper hinted it was for him, “a recovering governor.”
Wisconsin Gov. Scott Walker, a Republican, said the Senate effort reminded him of the House endeavor — which proceeded in fits and starts before ultimately passing. “It’s like deja vu all over again,” said Walker, predicting eventual success in the Senate, though he declined to offer a time frame.
Without Sandoval, few believe that is possible. Asked if the administration officials changed any minds over the weekend, the Nevada governor was blunt.
“Here? Likely not,” he said.