Wisconsin senator Ron Johnson, a Republican wildcard in the upper chamber’s health reform discussions, accused majority leader Mitch McConnell Friday of being duplicitous in his struggle to assemble 50 yea votes to pass the Better Care Reconciliation Act.

Johnson told the Green Bay Press-Gazette that the legislation’s changes to Medicaid were reasons for uneasy conservatives to support the bill. But he said that McConnell was representing the Medicaid overhaul as a façade, though he didn’t cite examples. “If our leader is basically saying don't worry about it, we've designed it so that those reforms will never take effect, first of all, that's a pretty significant breach of trust, and why support the bill then?” Johnson asked.

The Washington Post reported last week that McConnell told Sens. Rob Portman and Shelly Moore Capito, who both represent Medicaid expansion states, that the legislation’s “deepest Medicaid cuts are far into the future” and won’t ever see the light of day. A former GOP lobbyist and Capitol Hill staffer quoted by the paper mentioned an adjustment to Medicaid’s funding formula in the year 2025, specifically. An aide to Johnson told THE WEEKLY STANDARD that the Wisconsin Republican confirmed reports of McConnell's comments in conversations with colleagues.

It’s unclear which reforms Johnson had in mind, and how they would fail to be enacted were the Senate bill passed into law. The shift in Medicaid’s spending formula included in the measure, for example, is mandated over a 10-year period and is not optional. States would have the option to receive Medicaid dollars through a block grant starting in 2020, a preferred conservative method of providing states flexibility to manage their programs how they see fit. But this “option” would be codified. Any suggestion that it or the Senate legislation’s other Medicaid reforms would never be implemented is based on predicting future governing activity, either by Congress or regulators.

Still, Johnson’s remark, which he reiterated in the national media on Monday, is a touch of gray to an increasingly bleak picture for Republicans: Already down Sens. Rand Paul and Susan Collins in the vote count, they can’t afford to lose Johnson, a conservative skeptic of the original measure, or any other member, for that matter. By winning over Portman and Capito, who were also no votes, McConnell risks alienating the caucus’s right-leaning flank. Earning the support of Johnson and colleagues like Sens. Ted Cruz and Mike Lee could cost McConnell the center, which includes Dean Heller, a vulnerable incumbent in 2018 who told THE WEEKLY STANDARD he hadn’t heard about the Post report. The GOP cannot drop a single additional yea even on a procedural motion to take up the language as it exists before the Senate floor.

McConnell's office issued a statement to THE WEEKLY STANDARD that does not deny the substance of the charges from Johnson: “I prefer to speak for myself, and my view is that the Medicaid per capita cap with a responsible growth rate that is sustainable for taxpayers is the most important long-term reform in the bill," said the statement. "That is why it has been in each draft we have released.”

This post has been updated to include comment from the offices of both Sens. Johnson and McConnell.