Dean Heller is confronting attacks over his votes on legislation to repeal Obamacare by touting his vote for a bill that was never supposed to become law.
The Nevada Republican, who is up for re-election in 2018 and is considered one of the most vulnerable Republicans, angered conservatives when he flip-flopped by voting against a bill that he voted for in 2015 that would have immediately gutted Obamacare without a replacement. He also faces attacks from his Democratic challenger, who says he went back on a promise to not strip healthcare away from millions of people.
That has left the senator to defend a bill that many Republicans didn’t want to become law: the “skinny” repeal bill that eliminated only Obamacare’s individual and employer mandates and some of its taxes.
While not perfect, the skinny bill “protected coverage for our most vulnerable and provided relief to many hard-working Nevadans by repealing the most onerous provision of Obamacare, the individual mandate,” Heller said after the skinny repeal bill failed in a 49-51 vote in the Senate in late July.
Heller stands out as a senator touting his vote for the skinny bill, which most Republicans derided but voted for as an avenue to start talks with the House on a new repeal bill.
Heller announced at a news conference in June that he couldn’t support the first version of the Senate’s Obamacare repeal-and-replace bill that would have cut Medicaid by $770 billion over a decade. Popular Republican Gov. Brian Sandoval, who joined Heller at the news conference, expanded Medicaid under Obamacare, and the expansion has covered more than 200,000 people.
However, Heller voted to start debate on repealing Obamacare but then voted against a 2015 bill that repealed Obamacare without an immediate replacement. He supported the same bill in 2015, which was vetoed by former President Barack Obama.
Heller was among six Republican senators who voted for the bill in 2015 but voted against it this year. Several senators said they switched their votes because an immediate replacement is needed for Obamacare and the 2015 bill would have left Obamacare in place for two years while a replacement was crafted.
Both repeal measures failed in the Senate.
But Heller did vote in favor of the “skinny” bill that leadership brought up as a last-ditch effort to start negotiations on a new bill with the House.
While the skinny bill gutted the law’s individual mandate and some taxes, it did not touch spending for the law’s Medicaid expansion.
“The reason it was eliminated from the skinny bill was because of me,” Heller told local TV station KLAS in an Aug. 20 interview. “I am sure there were four or five other [senators from Medicaid] expansion states that were with me.”
Senate GOP leaders didn’t mean for the skinny bill to become law. Several Republican senators demanded a promise from House Speaker Paul Ryan that if the bill passed, he would go to conference with the Senate and not just take up the skinny bill in the House.
Ryan agreed to go to conference but did not promise that the skinny repeal bill would never become law.
The slim chance that skinny repeal could become law was a factor in Arizona Sen. John McCain’s decision to vote against it. Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska joined McCain in voting against the bill, and it failed 49-51.
Some Nevada political observers were confused by Heller’s decision to vote for the skinny bill after voting down straight repeal and the Senate bill to repeal and replace Obamacare.
“If you were going to write a guidebook on how not to handle an issue, Dean Heller has got one for you,” said Jon Ralston, longtime political reporter and editor of the Nevada Independent, on KNPR’s State of Nevada last month. “He could be a best-selling author: ‘Don’t do this.'”
Ralston noted that Heller “infuriated people on the Right by not voting for the full repeal or even the partial repeal that came before the ‘skinny’ repeal.”
Since the healthcare vote, Heller has touted several aspects of the “skinny” bill. He has turned to it as an example that he voted to keep his promise to Nevada voters to not take away access to healthcare.
“At the end of the day, low-income families and middle-income families still have healthcare,” he told KLAS.
But his primary opponent, Danny Tarkanian, has criticized Heller for not going far enough to repeal Obamacare.
“I support the clean repeal of Obamacare that Dean Heller voted for in 2015 and against in 2017,” Tarkanian said in a statement to the Washington Examiner.
Democratic challenger Rep. Jacky Rosen, D-Nev., said Heller’s skinny repeal vote showed he supports higher premiums and stripping healthcare from millions of people. An estimate from the Congressional Budget Office found that 16 million people could go without insurance under the skinny bill.
“Last month, Senator Heller promised that he could not vote for legislation that takes away insurance from tens of millions of Americans and hundreds of thousands of Nevadans. Last night, he voted to do just that,” according to a campaign statement.
Heller’s campaign said he isn’t done trying to repeal and replace Obamacare.
Last month he signed on to a proposal from Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., which would provide block grants for Medicaid and tax credits on the individual market. The senators have said the grants give states more flexibility to design health programs that work for their locality rather than imposing inflexible federal mandates such as those in Obamacare.
But one study said the proposal could cut Medicaid expansion funding to states and millions of people would lose coverage.
The proposal establishes a block grant from 2020-2026. In 2020, the block grant would equal about $140 billion, which is 16 percent less than projected federal spending for the Medicaid expansion and the tax credits, according to an estimate from the left-leaning think tank Center on Budget and Policy Priorities.
The think tank argues block grants would not only cut overall spending but also redistribute the funding across states based on “criteria unrelated to states’ actual spending needs.”
“In general, the plan would effectively punish states that have been especially successful at enrolling low- and moderate-income people in the Medicaid expansion or in marketplace coverage,” the think tank said. But it would impose less-damaging cuts on states that rejected the expansion or enrolled fewer people in Obamacare.
A Senate aide responded that Nevada would pay much more under Obamacare in 2020, when the state must pay for 10 percent of the Medicaid expansion funding. Under the Graham-Cassidy proposal, Nevada would have a 3 percent match.
Heller’s campaign also blasted the estimate, noting that it was from a liberal think tank.
“The Graham-Cassidy-Heller legislation would provide flexibility to the states to administer Medicaid or overhaul the system in a way that better suits the people of their state,” campaign spokesman Tommy Ferraro said. “The bill repeals the portions of Obamacare that hurt those who can least afford it, and put our health insurance industry on a better path forward to provide real relief to middle class families.”
