Despite a full-court press from the White House this weekend, many of the nation's governors remain unsupportive of the latest version of legislation that would replace the Affordable Care Act, which was released by the Senate late last week.
As the nation's state leaders gathered in Providence, R.I., this weekend for their annual summer meeting, numerous Trump administration officials, including Vice President Mike Pence, sought to convince governors to support the Senate's Obamacare repeal bill.
But the White House's efforts were not well received.
"Everyone's having a hard time getting their head wrapped around the numbers and how it doesn't mean it's just a gigantic shift of expenses from the federal government to the states," said Virginia Gov. Terry McAuliffe, the outgoing chair of the National Governors Association and a critic of Republican efforts to overhaul health care. "I think every governor is very concerned."
Governors' gravest worries are the proposed deep cuts to Medicaid, the per-patient cap on Medicaid spending and the phasing out of funding for states that expand Medicaid to more low-income people.
The governors were briefed on the Senate bill Saturday in a two-hour closed-door session with Health and Human Services Secretary Tom Price and Medicaid administrator Seema Verma. The federal officials sought to quell governors' concerns that the bill's funding cuts and Medicaid caps would result in millions of people losing insurance.
In the meeting, Price and Verma disputed Congressional Budget Office (CBO) estimates that 22 million people would lose coverage under the last version of the Senate bill by 2026, including some 15 million Medicaid recipients, according to governors who attended the briefing. The CBO is expected to release an updated estimate of this version early this week.
Even some Republican governors said it is difficult to discount the CBO numbers.
"I think you have to give some confidence to the CBO," said Arkansas GOP Gov. Asa Hutchinson, although he added that it's difficult to estimate the true impact of the legislation because it would allow individuals to choose what kind of coverage they want.
One GOP governor, Brian Sandoval of Nevada, is seen as particularly crucial to the debate. His support of a repeal bill would likely sway Nevada Republican Sen. Dean Heller's vote on the legislation. Sandoval opposed previous versions of repeal-and-replace legislation, and Heller cited Sandoval's opposition when he announced last month he did not support the earlier Senate bill.
But Saturday's closed-door meeting did not seem to change Sandoval's mind.
"I'm no different than I was," the governor told reporters after the meeting, according to The Washington Post.
He said he plans to come to a final decision on the bill this week.
With a slim 52-member majority in the Senate, Republicans have no votes to spare. Senators Susan Collins of Maine and Rand Paul of Kentucky have both signaled they will not support the current bill. If they lose the support of Heller or any other GOP senators, the bill would effectively be dead. That's why on Saturday night, Senate Majority Leader Mitch McConnell announced he would defer a vote on the bill until Sen. John McCain of Arizona, who is home recovering from a blood-clot surgery, could return to Capitol Hill to cast a vote.
That delay likely won't help the bill's chances.
The CBO's release this week of estimates on uninsured individuals could add to a drumbeat of opposition from governors who say Congress should abandon its efforts to overhaul Medicaid, at least for now.
Even some Republican governors who support health-care changes have said that Medicaid reform and other ACA reforms should be done separately.
"By mixing the two, you're looking at cuts not just in funding, but in services -- in key constituencies, in the elderly, for children," said GOP New Hampshire Gov. Chris Sununu on MSNBC after the new Senate bill was released. "These are things we just can't risk to lose."