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Trump takes softer approach to wooing Murkowski’s vote on health bill

Sen. Lisa Murkowski.

J. Scott Applewhite/Associated Press

Sen. Lisa Murkowski.

WASHINGTON — When Senator Lisa Murkowski last found herself at the center of a debate over repealing the Affordable Care Act, President Trump took to Twitter to chastise her. This time, Trump invited her to lunch, and her Republican colleagues are coaxing her with special sweeteners for her state.

While the senator from Alaska demurred on the president’s lunch invitation (she cited a prior commitment in her home state), her fellow Republicans are clearly taking a new tactic this time, seeking to woo rather than shame her into voting their way.

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But so far, the senator is keeping her colleagues and constituents guessing.

“Everybody’s on edge until she announces that she’s not going to vote for it,” said Alaska state Senator Bill Wielechowski, a Democrat. “At some point, there could be an offer made that it would be hard for her to refuse.”

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In a last-ditch effort to fulfill Republicans’ years-long ambition of repealing the Obama-era health law, Louisiana Senator Bill Cassidy and South Carolina Senator Lindsey Graham introduced a bill that would strip away government mandates and transform Medicaid into a lower-cost block-grant program.

The result would be heavy Medicaid cuts in some of the most populous blue states, including California, New York, New Jersey, and Massachusetts, which stands to lose $8 billion in federal Medicaid money by 2027, according to an estimate by the left-leaning Center on Budget and Policy Priorities.

The bill has divided Republican governors, while health care advocates and the health care industry — including hospitals, doctors, and insurance companies — say it would disrupt insurance markets and wreak havoc in many states.

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Along with Arizona Senator John McCain, Murkowski has surfaced yet again as a crucial swing vote in the chamber, which has 52 Republicans. Two other GOP lawmakers are already expected to vote against the bill, Susan Collins of Maine and Kentucky’s Rand Paul, so party leaders cannot afford any more defections (with the minimum 50 aye votes, Vice President Mike Pence would break a tie in favor of the bill).

Although McCain sunk the last bid to repeal Obamacare with a memorable thumbs down on the Senate floor, he may be more easily persuaded by Graham, his longtime ally on the Hill.

So far, Murkowski and her aides have told reporters that the senator is mulling over the bill and weighing its relatively small impact on Alaska. She won’t have long to think it over.

In order to pass the health care overhaul with just a simple majority, as now allowed under arcane Senate rules, Republicans will have to act before Oct. 1, the beginning of a new fiscal year, when the usual 60-vote threshold to end a filibuster will be back in effect for the measure. Senate majority leader Mitch McConnell plans to bring the bill to the floor next week, his spokesman said on Wednesday. This is McConnell’s third push in six months to repeal the Affordable Care Act and replace it with a Republican vision.

In July, after Murkowski broke with Republicans on an earlier version of a replacement bill, the president singled her out in a tweet that said she “really let the Republicans, and our country, down yesterday. Too bad.’’ Around the same time, the Alaska Dispatch News reported that Interior Secretary Ryan Zinke called Murkowski to say her no vote meant Alaska had fallen from favor in Washington — an ominous warning for a state that depends heavily on the federal government.

Tuckerman Babcock, Alaska’s Republican Party chair, prefers the Trump administration’s new strategy in dealing with the senator.

“I think that it’s more likely to have success,” he said in a phone interview. “It’s a much better way to interact with our legislators.”

Regardless of how lawmakers in Washington get there, Babcock said he wants to see movement on health care. “To repeal Obamacare one way or another, to one extent or another, is something they must attempt to do,” he said.

But on the ground in Alaska, where health care is more expensive than in any other state in the country, the push for Murkowski to oppose the Graham-Cassidy bill is apparent. On Tuesday, Alaska Governor Bill Walker, an independent, signed onto a letter urging Senate leaders to forget the new, divisive bill and opt for bipartisan health care overhaul legislation that helps stabilize the market.

At Murkowski’s office in Anchorage, Wielechowski, the state senator, said demonstrators gathered to send a clear message that they want to keep their health care coverage under the Affordable Care Act.

Alaska is one of 31 states, a few of them Republican, that opted to expand Medicaid under the health care law. According to the Center for Budget and Policy Priorities, Alaska would stand to lose about $844 million in Medicaid funding over the next decade under the proposed legislation.

In Alaska, television programming has been saturated with ads imploring Murkowski to vote against the bill, said Marc Hellenthal, a veteran Republican strategist in Alaska. “All the ads, all the money being spent is for her to stay the course and buck Trump,” Hellenthal said.

But Murkowski, who was first elected to the Senate in 2002 and remains popular, has no imminent political risk in her state. She is not up for reelection until 2022.

Already buried in the Graham-Cassidy bill is a provision that could delay the cap on Medicaid funding for “low-density states,” described as having a population density of less than 15 people per square mile. According to a report from Business Insider, the legislation will be updated to include a bump in federal funding for those sparsely populated states with health care costs more than 20 percent above the US mean — meaning just North Dakota and Alaska.

A report from the Independent Journal Review said the new draft of the bill would have three other added bonuses for Murkowski’s state, including the continuation of Obamacare premium tax credits, which are the main subsidies for buying health care on the insurance exchanges.

Still, Hellenthal, who has worked as a pollster in the state since 1979, doubts Murkowski would sacrifice her principles for a bit of horse trading on the Hill.

“Trump likes to pride himself as a dealmaker,” he said. But “Lisa really isn’t that susceptible to cutting a deal.”

On Wednesday, the president chose a different Republican senator to chide over breaking with the party, calling Paul — who came out immediately against the Graham-Cassidy bill because it does not go far enough — a “negative force” when it comes to passing the health care bill.

At least when it comes to Twitter, Trump seems to have left Murkowski alone for now.

Julia Jacobs can be reached at julia.jacobs@globe.com.
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