Grand old party

Nevada Republicans are facing the difficulties of following the lead of their president-designate in a state that voted against him.

Physicians and patients are complaining about the promised loss of the Affordable Care Act.

Nevada’s Democratic Assembly speaker has replied to a congressional leader’s inquiry on how to deal with federal/state relations with a list of complaints about Trump’s policies.

An essay by two Nevada physicians calling on GOP legislators Mark Amodei and Dean Heller to protect the ACA ran on the website of the Nevada Appeal under an ad calling on Heller to vote against confirming Trump’s nominee for head of the Environmental Protection Agency.

Various groups and individuals are employing means from letters to the editor to television spots to get Heller to vote against Trump nominees for a variety of posts.

A telephone news conference by the Center on Budget and Policy Priorities brought the jarring news that perhaps 370,000 Nevadans could be cut loose from health insurance under GOP plans—a number that could rise to three quarters of a million.

More than 150 state legislators, including two from Nevada, signed a letter to Trump calling on him to declare his support for LGBT rights.

Gov. Brian Sandoval—himself a Republican—warned GOP congressional leaders against cutting off Medicaid expansion funds before a new health care program is created.

Even the supposed Russia/Trump alliance has raised its head in connection with Nevada. U.S. Rep. Mike Conaway, a Texas Republican, offered one of the less convincing defenses of alleged Russian interference in the election by analogizing it to Mexican celebrities performing openly at Nevada political events:

“Harry Reid and the Democrats brought in Mexican soap opera stars, singers and entertainers who had immense influence in those communities into Las Vegas, to entertain, get out the vote and so forth,” Conaway told the Dallas Morning News. “Those are foreign actors, foreign people, influencing the vote in Nevada. You don’t hear the Democrats screaming and saying one word about that.”

Nevada tribes are concerned about what the ACA’s repeal would mean for them, particularly because of complications with the Indian Health Services.

It’s all the latest example of the way politicians campaign in poetry but govern in prose. Congressional Republicans—always uncertain about the volatile leader their primary and caucus voters foisted on them—are feeling their way as they decide whether to go out on limbs for him.

MarketWatch.com on Trump: “One presidential candidate wants to end loopholes for the ’very rich.’ He’s against trade deals that allow foreign ’sweatshops’ to steal American jobs. He backs ’prevailing wages’ for U.S. positions filled by foreigners with special visas. He supports universal health-care coverage and an ’individual mandate.’ And he says he’s the guy to rebuild America, a job that could cost hundreds of billions of tax dollars.”

“He was elected by crossover Democrats who came over in Reagan’s time and Nixon’s time,” Nevada political scientist Fred Lokken said of Trump. “It’s not the typical Republican coalition that put him in office.”

Some of those voters expect things from government. Republicans must navigate treacherous ground between their traditional supporters and Trump die-hards, who until recently may have been independents or Democrats. Meanwhile, Democratic leaders are free to attack from left and right. And it’s pretty clear Trump should not expect a traditional new president’s honeymoon period. This week, Democrats.com sent out a mailing calling the not-yet-in- office Trump administration “the most corrupt administration in history.”

“Before the ACA, women could be denied coverage because they were victims of domestic violence or had previously had a C-section,” wrote Henderson OB-GYN Keith Brill in the Las Vegas Sun. “Before the ACA, women were routinely denied, delayed or limited when seeking affordable, comprehensive maternity coverage. Before the ACA, women could even be charged higher premiums than men for identical coverage. The ACA has made tremendous strides to expand coverage for women by fixing these problems.

“Now, 455,665 women in Nevada have no cost-sharing for preventive services such as gynecological cancer screenings and contraception, 329,000 have benefited from the ACA’s prohibition on lifetime limits on health benefits. About 857,000 Nevada women have health insurance coverage. Do we want to put those citizens in jeopardy?”

Brill, chair of the Nevada section of the American Congress of Obstetricians and Gynecologists, was appealing to Sen. Heller to protect the state’s women patients and doing it in terms that makes it difficult for Heller to stay straight with both his female constituents and GOP ideologues for whom repeal of “Obamacare” is a party article of faith.

In the Nevada Legislature, Assembly Speaker-designate Jason Frierson and Senate Democratic leader Aaron Ford have written to Heller asking for information on whether, under an as-yet unwritten alternative Republican health care plan, there will continue to be mandates for pre-existing conditions, policies that allow children to keep coverage on their parents’ plans until age 26, coverage under expanded Medicaid eligibility—plus pledges of support for women’s health care.

Meanwhile, Frierson received a letter from U.S. Rep. Jason Chaffetz of Utah, who chairs the House Committee on Oversight and Government Reform. It invited Frierson to complain about federal unfunded mandates, regulations or other grievances Nevada has against the feds.

Frierson knew what Chaffetz was up to and wrote back suggesting retention of the ACA, an end to “hateful” immigration language, and governing instead of campaigning.

In Congress, meanwhile, Republican leaders are being put in difficult positions of real stakes, and they must decide how reckless they want to be. “We have China clearly escalate based on his pronouncements,” Lokken said. “We could have war with China. That just doesn’t make sense to Republican leaders.” He said they are equally unnerved by Trump’s Israeli policies.

On matters of less moment, Trump can put people like Amodei and Heller in positions where they have to choose between the party leader and the party.

Trump is “proposing things without clearing them with the party,” Lokken said. “An Obama-style health program for everyone—that’s not the Republican program. Where it is that coming from?”