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 convince 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. Senate Republicans were expected to try to move toward a vote on the measure this week, but late Saturday, Senate Majority Leader Mitch McConnell (R-Ky.) announced a delay in starting the debate because Sen. John McCain (R-Ariz.) will have to stay in Arizona recuperating from surgery for a blood clot above his left eye.
Whether the unexpected postponement will provide Senate leaders with the time to round up the votes they need for passage or merely freeze the process or even harden the opposition was not immediately clear. But the sudden change in plans marked another unexpected twist in the saga of the G OP’s struggles over health care this year.
The delay, however, does not change the potentially central role for Sandoval. More than any other Republican in the country right now, the centrist governor of Nevada could hold the power to sink or salvage the health-care bill that Senate GOP leaders had hoped might get a vote in the coming days.
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 Trump.
All weekend, he has been besieged — by reporters taking his temperature and by administration officials, including Vice President 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 told reporters 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. Sandoval 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 (R), a vociferous opponent of the Republican health-care proposal, seeming to incorrectly link the length of disabled waiting lists to the expansion of Medicaid.
A spokesman for the vice president said Saturday evening that Pence was not trying to link the two but was only talking about need for reforms.
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.
And he 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 a reporter 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 with 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 from a state where Trump lost, and he rose through the ranks in a different wing of the Republican Party than the president.
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 that 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.”
The prospect of voting on the health-care bill in the coming days was cast into doubt late Saturday when Sen. John McCain’s office said he would be in Arizona this week recovering from surgery to remove a blood clot from above his left eye.
“On the advice of his doctors, Senator McCain will be recovering in Arizona next week,” said McCain (R-Ariz.) spokeswoman Julie Tarallo.
Two Republican senators — Rand Paul (Ky.) and Susan Collins (Maine) — have said they do not intend to vote yes to proceed to the bill. Along with all 48 senators in the Democratic caucus — and without McCain — that would be enough to block the bill from proceeding to debate.
A McConnell spokesman did not immediately respond to request for comment on whether the Senate still planned to vote.
Sen. Thomas R. 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 the health-care bill.
Wisconsin Gov. Scott Walker (R) said the Senate effort reminded him of the House endeavor — which proceeded in fits and starts before ultimately passing. He predicted eventual success in the Senate, though he declined to offer a time frame.
Without Sandoval, few believe that is possible. Asked whether the administration officials changed any minds over the weekend, the Nevada governor was blunt.
“Here? Likely not,” he said.