WASHINGTON — A tiff between President Donald Trump and Senate Majority Leader Mitch McConnell bodes ill for Nevada, where the governor and lawmakers are trying to shore up the state’s insurance exchange while Congress finds a path forward on health care reform.
Trump said McConnell’s job should be on the line if he doesn’t deliver on the Republicans’ seven-year quest to repeal the Affordable Care Act.
“I’m very disappointed with Mitch,” Trump told reporters at Bedminster National Golf Club in New Jersey.
Uncertainty over reform of the national health care law has prompted insurance companies to pull out of public exchanges and left consumers of those plans bracing for higher premiums.
Nevada officials were told earlier this year that no insurance carriers would provide public plans through the ACA to 14 rural counties in the state. The public exchanges in the most populous counties, Clark, Washoe and Nye will continue next year.
But one of the largest carriers, Anthem, announced this week that it would leave the state altogether.
Gov. Brian Sandoval said he is working to make sure people in every Nevada county can purchase plans on the state’s public exchange.
More than 89,000 people in Nevada are covered by insurance plans purchased from the exchange.
About 10 other states are grappling with insurance carriers leaving state marketplaces set up under the ACA, according to the Kaiser Family Foundation. About 17 counties nationwide are at risk of having no carrier in 2018 — and 14 of those are in Nevada.
Republican and Democratic leaders said stabilizing the markets will be a top priority for Congress when it returns from its August recess. But Republican squabbling has marred the first week of the break for Senate Republicans.
President blames McConnell
Trump has publicly laid the blame for failing to repeal and replace the ACA, known as Obamacare, on McConnell, who failed to muster the 51 votes needed to repeal the law after a replacement plan failed.
The repeal effort fell apart after weeks of wrangling to bring conservatives and centrists together to pass a bill. Democrats were united in their opposition.
A bill to repeal and replace the ACA with a GOP plan that included cuts to Medicaid was opposed by several Republican senators from states where the program was expanded under the ACA, including Sen. Dean Heller, R-Nev.
After a broad repeal bill failed, the Senate pushed a smaller “skinny” repeal bill, which died in dramatic fashion when Sen. Susan Collins, R-Maine, Sen. Lisa Murkowski, R-Alaska, and Sen. John McCain, R-Ariz., voted against the legislation.
Heller voted for the “skinny” repeal bill, and is now in talks with several GOP senators to craft a bill that would repeal Obamacare mandates and provide states with block grants for health care spending.
Heller said before the recess that the legislation would be considered “when we have 50 votes.”
Trump urged McConnell Thursday to follow through with his pledge to repeal the law.
The president took to social media to blast Republicans: “After 7 years of hearing Repeal & Replace, why not done?”
The presidential scolding took place after McConnell, back in Kentucky, told constituents that the president had little legislative experience and “excessive expectations” about the democratic process and the difficulty of cobbling together a complex bill.
White House spokeswoman Sarah Huckabee Sanders told reporters Thursday that the president was frustrated, but declined to speak on the relationship.
“You can see the president’s tweets,” Sanders said. “Obviously there’s some frustration.”
Minutes after Sanders made those comments to the media, Trump sent out another missive on Twitter telling McConnell to get repeal, tax reform and an infrastructure bill on his desk to sign. “You can do it.”
Trump then used two exchanges with reporters at Bedminister, where he is on a working vacation, to criticize McConnell.
Stabilizing the markets
Meanwhile, Sen. Catherine Cortez Masto, D-Nev., said Anthem’s decision to leave the Nevada market “should be a reminder that our priority now should be to stabilize the markets.”
Cortez Masto urged the Trump administration to fund the Cost Sharing Reductions provided by the ACA “to help consumers afford insurance and ensure providers do not leave the markets.”
After Republicans failed to pass any of its proposals on repealing and replacing the ACA, some GOP lawmakers, including Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, have suggested a narrow, bipartisan bill to make needed changes to the ACA and stabilize the insurance markets.
About 17.5 million people buy plans on public exchanges and could see sizeable increases in premiums, according to the Kaiser Family Foundation.
About 49 percent of people receive employer-sponsored insurance plans, which have seen modest premium increases of roughly 3 percent per year, according to the Kaiser Family Foundation. About 74 million people are insured through Medicaid.
McConnell has said that when the Senate returns from recess, it will take up tax reform. Many Republicans hope that an agreement on that issue will deliver the first major legislative victory for Trump.
Tax reform will be taken up by the Senate Finance Committee, on which Heller, the most vulnerable Senate Republican up for reelection in 2018, has a seat.
Heller said he will be “front and center fighting for policies that allow hardworking Nevadans to take home more of their paychecks and encourage businesses to expand, hire and invest in our communities.”
Senate Democrats have warned that they will oppose any tax cuts for the nation’s wealthiest people.
Contact Gary Martin at 202-662-7390 or firstname.lastname@example.org. Follow @garymartindc on Twitter.