In the days leading up to a Republican vote in Congress to repeal and replace— or just repeal— Obamacare, 1,500 miles away in Colorado the Republican candidates for governor were seething.
“I think it’s an utter disgrace that literally every Republican that’s currently in Congress campaigned on repealing the ‘unaffordable’ care act and now that they have the opportunity to do it they’re wimping out,” said Victor Mitchell, an entrepreneur and the only GOP candidate so far to have previously served in the legislature.
A day later those Republicans, including Colorado GOP U.S. Sen. Cory Gardner, voted in the afternoon to begin debate on a health care bill with many not even knowing how a bill might look. Arizona GOP Sen. John McCain, who flew to D.C. for the vote after being diagnosed with brain cancer, acknowledged the Senate had crafted its bills “behind closed doors.” Later, the Senate voted on a plan to replace Obamacare with Gardner supporting it, but it fell through.
In recent weeks, Republican leaders have tried to nail down a vote on their seven-year promise to obliterate former Democratic President Barack Obama’s signature health care law. But their attempts collapsed, even though Republicans hold the House, the Senate and the presidency.
“We seem to control all the things necessary to make some important decisions on an extremely important topic and we can’t even get a vote to have a vote,” said a frustrated George Brauchler on the eve of the Senate debate. “Just disappointing.”
The Arapahoe County-area district attorney who prosecuted the Aurora theater shooter said he hoped Republicans would at least get a vote on some kind of repeal plan so voters can see where members of Congress stand.
Brauchler’s wish came true Tuesday when Vice President Mike Pence broke a tie on a procedural measure to allow debate on a new law that could end Obamacare. Two GOP senators— Susan Collins of Maine and Alaska’s Lisa Murkowski— voted no. And it came true again that evening with a failed vote on a comprehensive Obamacare replacement package that failed 43-57 with nine Republicans casting ‘no’ votes.
The July 25 votes were just the latest in a series of proposed health care laws since the election of President Donald Trump that were cobbled together quickly and in secret only to hit resistance from every Senate Democrat, as well as from Republicans on the far right and those who are more moderate.
Doug Robinson, an investment banker and political newcomer running for governor in Colorado, said he did not want to see members of the Senate come home for their August recess without passing a bill.
“I’m a guy who negotiated deals for a living … we used to lock people in the room and withhold food and say, ‘You will come up with a solution,’” he said, only half in jest. “We need to do something like that … They owe it to the American people to come up with not just a repeal, but a repeal and replace.”
For the past seven years, Republicans in Congress have taken symbolic votes to repeal a federal health care law that has grown roots in states both red and blue and brought more Americans onto the health insurance rolls largely by expanding Medicaid and mandating coverage with the threat of a fine.
Trump campaigned on scrapping the law and promised “something terrific.” Republicans running for Congress, too, have made repealing Obamacare a consistent rallying cry. In May, a plan to dismantle the law passed the U.S. House. In the Senate, similar proposals have hit snags. The nonpartisan Congressional Budget Office, which analyzes proposed laws, said the GOP health care plans would leave more than 30 million people without health insurance. Outside D.C., protests have raged in the districts of GOP U.S. senators, including in Colorado where U.S. Sen. Cory Gardner is one of 13 Republicans tasked with helping draft a bill. In June, nearly a dozen disability rights protesters were arrested in Gardner’s Denver office.
Two other Republicans running for governor, Larimer County Commissioner Lew Gaiter and retired banker Joanne Silva of Loveland, said they would like to see more outreach to Democrats to craft a bipartisan law.
“I think they should be involved in this process and I think if they were it would be easier to get something done,” Silva said.
Disabled Air Force veteran Greg Lopez, who has a background in financial planning, was president of the Denver Hispanic Chamber of Commerce and served as the mayor of Parker in the 1990s, said he hoped federal lawmakers would “modify” Obamacare. “I expect more leadership from both sides,” he said.
As a Trump supporter, Steve Barlock, Trump’s Colorado co-chair who is also running for governor, said the movement that elected Trump is not the same that earned many U.S. senators and congressmen their seats.
“What we need to do is have them realize that is a movement, that politics has changed in the last eight years on the Republican Party and they need to either conform to what the people want or get the hell out of office,” he said.
Colorado’s GOP candidates for governor offer their own solutions
Regardless of what happens in Washington, Republican candidates who want to replace term-limited Democratic Gov. John Hickenlooper say they should have more flexibility to deal with health care as a state.
They blast Colorado’s Obamacare exchange, Connect For Health, and they rip Obamacare every chance they get. Some are looking to red states as models and others to states more blue.
Victor Mitchell, 51, who lives in Castle Rock and made his millions founding companies, believes health insurance should largely be for specialty care and emergencies. “Somehow we’ve gotten it to, ‘Oh, insurance should cover everything,’” he says. As governor he would work to “immediately” pull out of Colorado’s Obamacare exchange.
An effort to repeal that state exchange failed in the last legislative session where Democrats control the House and Republicans control the Senate. Mitchell’s preference, he says, would be to work through the legislature to do it, “but it could be done without the legislative process,” he says. (The exchange was created through legislation and is overseen by a legislative committee.)
He wants more transparency in health care pricing and to use block grant money to create what he calls “young entrepreneur-nurse-practitioner-physician-assistants-type clinics” that could handle common procedures like mammograms and colonoscopies. He likes what he saw in southern Virginia, for instance, where he found an affordable clinic serving 25,000 patients a year on a $1.5 million budget without accepting Medicaid, Medicare, or private insurance. Instead the clinic takes in private donations, small block grants and negotiates directly with pharmaceutical companies for prescription drug vouchers.
“It’s very innovative,” Mitchell says. “There’s other clinics that are on a pay-for-service basis or a monthly subscription basis. We lack imagination, we lack creativity. There are options out there today that are working effectively.”
So as governor Mitchell would encourage the growth of such clinics by taking proposals and giving launch money and block grants. “You have to let the market figure this out,” he says.
Other candidates are looking elsewhere for models.
George Brauchler, who has gotten health insurance through the Army since he was on active duty, likes what the Republican governors of Wisconsin, Arizona and Kentucky have done. Wisconsin’s Scott Walker, for instance, asked the Trump administration for approval to drug test Medicaid recipients. Brauchler wouldn’t want to do it as a way to kick people off the insurance rolls, he says, but to as a vehicle to find out who needs state-funded help for rehabilitation.
“That’s the kind of thing I think we ought to be doing here and we ought to be looking at,” he says, adding that he likes the idea of work requirements for able-bodied residents on Medicaid, a plan GOP governor Matt Bevin in Kentucky wants to implement to control costs there. (Kentucky’s former governor, Democrat Steve Beshear, expanded Medicaid under Obamacare.) In Arizona, state officials under GOP Gov. Doug Ducey asked for federal approval to require able-bodied residents on Medicaid to either have a job or be looking for one if they want to stay enrolled. Brauchler believes such programs incentivize people to get “off the Medicaid dole.”
In Colorado he would also want to look at who is on the upper end of the income range of those on Medicaid here and find out what kind of costs and payments they could realistically pay for copays that’s higher than those on the lower end.
Brauchler, too, wants an alternative to Colorado’s health exchange, but acknowledged he would need buy-in from lawmakers.
Doug Robinson recently retired from his high-finance job to run for governor full time and gets insurance for his family through COBRA for about $1,800 per month with what he called a fairly high deductible. He fears at the rate he expects premiums to go up, he’ll eventually have to shell out up to $4,000 for his family of four.
Robinson is looking to a different state for ideas: Rhode Island. That state, which under a Republican governor in 2009 asked the George W. Bush administration for more leeway with its Medicaid program is now implementing it under a Democratic governor.
“A big expense in their Medicaid is older people that are in nursing homes,” Robinson says of The Ocean State. “And the average cost is six or seven thousand dollars a month for a nursing home. A lot of them would prefer to be in their home with a home-care solution. And that’s half that cost.”
In Rhode Island, nurses who are paid in part through Medicaid dollars provide in-home care to elderly Medicaid recipients who opt for that instead of a nursing home.
“That’s something that we could absolutely look at doing here in Colorado that I think could have a meaningful impact,” Robinson says.
Cheerleaders of the Rhode Island model have called it “classic conservatism: reduce federal rules, give states more autonomy and let them keep some of the savings.” But critics, like the Center on Budget and Policy Priorities, have called it a “‘sweetheart deal’ between the Bush Administration — in its final week of office — and the Republican governor of Rhode Island, in which the federal government effectively unloaded additional federal money on the state and gave Rhode Island federal funds beyond what it would receive under the regular Medicaid program, in return for the state accepting a cap on its Medicaid expenditures at an inflated level that it never expected to reach anyway.”
Robinson is also a fan of health savings accounts and incentives for healthy living. He would want to see about raising Medicaid copays for able-bodied adults without kids and perhaps charging them a monthly premium.
“Give it to Colorado, give it to the other states, and we’ll figure it out if the federal government can’t,” he says of his health care philosophy.
Colorado has received 11 different waivers from the feds already, which provide extra sets of benefits for Medicaid recipients here. And while there are some overarching themes that might be transferable among states the details might vary so much that it can be hard to compare them from state to state, says Marc Williams, spokesman for the Colorado Department of Health Care and Financing.
“There’s a saying in Medicaid,” Williams says. “If you’ve seen one Medicaid program— you’ve seen one Medicaid program.”
Steve Barlock is another candidate for governor who wants to see movement in Washington. He would be fine with a straight-up repeal of Obamacare without any replacement and he would “love” to repeal Colorado’s exchange.
As governor, he says, he would make sure the state’s health commissioner is an investigator. “He’s going to look into where this money is going,” says Barlock, who doesn’t believe the government is telling the truth about Colorado’s health care finances.
Colorado doesn’t technically have a health commissioner, but does have an insurance commissioner. The top bureaucrat who oversees Medicaid spending in Colorado is the director of the Department of Health Care Policy and Financing, who serves at the pleasure of the governor. That person is appointed by the governor, but needs confirmation by the state Senate.
“I believe the globalist outsiders are making money off of Colorado instead of keeping the taxpayers’ money in Colorado and working for them,” Barlock says. Barlock, who says a “globalist Republican is worse than a globalist Democrat,” isn’t looking at what other states have done— particularly not Massachusetts under Gov. Mitt Romney. (Republican rival Robinson is Romney’s nephew.)
Joanne Silva, however, likes what Romney did for the Bay State that inspired the individual mandate for the federal Affordable Care Act.
“I think other states could kind of take a look at what he did there and see if that’s something that they could use,” she says, adding she would even be open to a single-payer option “as long as it worked.”
For his part, Larimer County Commissioner Lew Gaiter stayed largely away from specifics when talking about health care policy. He likes some parts of Obamacare: No losing insurance for pre-existing conditions, for instance, and children being on their parents plans until they’re 25.
“I like some of those things that make it possible that people can get health care,” he says, while cost is an area that still needs more debate. He would work with the medical community to rein it in. He hasn’t been paying close enough attention to what other states are doing to say whether there might be something to emulate in Colorado. He said he wants to make sure there’s a “good, effective safety net for all the citizens of Colorado” and that everyone has adequate access.
Lopez says he is not looking to other states for potential models. What would set him apart in the broad field for governor on health care, he said, is that he wants to make sure those who need a safety net the most are taken care of and those who can afford health care have more choices to obtain it. He said he would execute such a task by talking with those in the health industry.
“They’re the ones that have the solutions,” he said. “They’re the ones who have true optics as to what’s going on.”
Their message to Cory Gardner
Colorado’s U.S. Sen. Cory Gardner has been held up as a “swing-state case study” for the Republican Party’s problems passing a health care bill in Congress.
Gardner is head of the National Republican Senatorial Campaign Committee, which means it is his job to help Republicans get elected to the U.S. Senate in 2018, and it makes him about as establishment Republican as establishment Republican gets in Washington. But he also represents Colorado, which went for Hillary Clinton for president by about five points. While other senators are up for reelection next year, Gardner will not face voters again until 2020.
In the past few weeks, Democratic Gov. John Hickenlooper has been lobbying Gardner to do what he can to ensure Americans don’t lose insurance coverage under federal health care legislation.
This week, as Senate Majority Leader Mitch McConnell of Kentucky signaled he wanted to hold a vote on some kind of health care law, Colorado’s GOP candidates for governor each had a message for Gardner. (Gardner voted for the procedural measure to begin debate.)
“I think that he should absolutely vote to repeal the ‘unaffordable’ care act at the earliest possible time,” says Mitchell. He added that “unfortunately we’ve had other people, other congressmen— and one fairly well known here in Aurora whose wife is the attorney general— who voted to keep the ‘unaffordable’ care act, which was just a disgraceful vote.” (Colorado’s attorney general is Cynthia Coffman, who is considering a run for governor.)
“I think we need to have a vote even if that vote turns out to be unsuccessful just so we can see where members of Congress are,” says Brauchler. “I don’t think anybody on either side of this issue can tolerate indecision and inaction.”
Robinson urged Gardner not to come home without movement on a bill.
“I know you want to get back to [Yuma] and see your family and so on,” Robinson says. “Have them come to Washington for August because we need a plan.”
Silva says slow down and try to get some Democrats on board. Gaiter hopes Gardner takes the time to read what’s in the bill.
“There’s so many Republicans that we call fence-walkers that are high-up business people that walk both sides of the fence,” Barlock says. “And I hope Cory does not listen to those people who side with Hickenlooper and the Republicans and who throw money both ways. And I hope Cory actually looks at what the people want and does that, and not [what] the powerful want.”