No one was terribly surprised that some centrist Republican senators such as Maine's Susan Collins balked at backing a bill to roll back Obamacare's coverage expansions, weaken its consumer protections and slash Medicaid.
But what about Sen. Jerry Moran of Kansas, who led the GOP's successful campaign to win control of the Senate in 2014? When a conservative party stalwart like Moran from a deep-red state voices opposition, Senate Majority Leader Mitch McConnell knows he has big trouble ahead in securing the votes of 50 of his 52 GOP colleagues to pass his repeal-and-replace bill.
Last week at a town hall meeting in rural north-central Kansas, the popular second-term Republican senator told an audience of 150 that he had major problems with the current version of the Senate's Better Care Reconciliation Act. The Congressional Budget Office projected the bill would cut federal Medicaid spending by 26% in the first decade and 35% in the second.
"I'd be surprised if Sen. Moran reversed himself and supported anything like this bill," said Tom Bell, CEO of the Kansas Hospital Association, which strongly opposes the bill and whose members have had many discussions with Moran and the state's other GOP senator, Pat Roberts. "He said he didn't think it was best for the state, and I expect he'll maintain that position until he sees a better bill."
Moran stressed that he didn't want to cut back Medicaid, questioning why that should even be included in the bill. "I have concern about people with disabilities, the frail and elderly," he said, according to the Washington Post. "Medicaid, except for the (expansion) part, is not really a part of fixing the Affordable Care Act."
He said he'd met Kansans who "tell me they are better off" because of the ACA. While he didn't promise to vote against the bill if McConnell brings it up for a vote this month, he said he'd rather not have legislation rushed through on a party-line vote and would prefer holding legislative hearings first.
About 10 Republican senators now have expressed misgivings about the Senate repeal-and-replace bill, including moderates such as Collins, ultraconservatives like Ted Cruz and Rand Paul, and even GOP reliables such as Moran and North Dakota's John Hoeven. McConnell reportedly is willing to add features to win over holdouts, such as boosting funding for substance abuse treatment to sway Sen. Shelly Moore Capito of West Virginia and loosening insurance rules to woo Cruz.
But Moran's statements last week make it hard to envision what McConnell could offer to snag his support, given that phasing out the Medicaid expansion and capping and cutting Medicaid spending are central parts of the bill. Without the estimated $772 billion in Medicaid spending cuts over 10 years, McConnell would have no way to pay for the bill's premium tax credits or to achieve its deficit reduction.
Bell said the bill's huge Medicaid changes will make it difficult for Moran to vote yes. "People like Sen. Moran are saying we should have a separate policy discussion about Medicaid, and it shouldn't be part of this really, really difficult political and policy discussion we're already in," he said.
And Bell doubts Moran can be bought off with more money for his state, such as a more generous Medicaid payment growth formula for non-expansion states such as Kansas.
Indeed, the Kansas Hospital Association and nine other healthcare organizations sent a letter to Moran last month noting that under the Senate bill, Kansas would lose its opportunity to receive extra federal funding to expand Medicaid. The GOP-controlled Kansas Legislature recently voted overwhelmingly in favor of expansion, but Republican Gov. Sam Brownback vetoed the measure and lawmakers fell just short of overriding the veto.
Bell predicted that if the Republican repeal-and-replace effort dies, there's a "decent chance" that Kansas would accept the Affordable Care Act's expansion of Medicaid coverage to low-income adults.
While some wavering GOP senators likely are fretting about getting primaried from the right if they oppose the repeal bill, Bell doesn't think Moran, who won his 2016 race with 62.4% of the vote, has to worry about that. (The Kansas chapter of Americans for Prosperity, a conservative group that strongly opposes the ACA and Medicaid expansion, did not respond to a request for comment).
"Jerry Moran is probably one of the popular politicians Kansas has had for quite some time," Bell said. "And his popularity has increased with his decision on this bill."
