Key GOP senators to watch on ObamaCare

The Senate is heading into a critical two-week stretch, where GOP leaders are aiming to hold a vote before July 4 on an ObamaCare repeal-and-replace bill that hasn’t yet been fully written.

It’s crunch time, as leadership needs to finish the bill and ensure at least enough moderates and conservatives support the final product. It won’t be an easy task.

That’s because some lawmakers are frustrated with the process. Others are staking out positions on certain policies — such as how slowly to phase down Medicaid expansion — but say they are working toward a yes. And two have major concerns about the bill’s direction.

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Senate Republicans have a slim 52-48 majority. They can only lose two votes, assuming Vice President Pence breaks a tie, under the fast-track budget maneuver the GOP is using to avoid a Democratic filibuster.

Here are the major GOP votes to watch over the next two weeks:

Sen. Mike Lee (Utah)

As one of the most conservative senators, Lee has demanded for the “full repeal” of ObamaCare in the past.

He’s had other conservatives by his side. In late February, Lee — along with Sens. Rand Paul (R-Ky.) and Ted Cruz (R-Texas) — each sent out the same tweet:

“2 yrs ago, the GOP Congress voted to repeal Obamacare. That 2015 repeal language should be the floor, the bare minimum,” they each tweeted, along with the hashtag “FullRepeal.”

In the House, the hardline conservative Freedom Caucus helped move its chamber’s bill to the right. But Senate leadership is looking to soften some of those provisions, such as a slower phase out of Medicaid expansion and possibly stripping out a waiver allowing states to let insurers charge consumers more based on their health status.

Lee doesn’t like how the bill is shaping up.

“It’s not yet clear what it is going to look like at the end of the day,” Lee said June 11 on ABC’s This Week, adding that he has some “grave concerns about what we’re doing so far.”  

Sen. Rand Paul (Ky.)

When the House was hammering out its bill, Paul toted a copier to the other side of the Capitol in a hunt to find and copy the legislation.

He came out empty-handed, as staff said the bill was still being written, but the stunt achieved its goal — highlighting what he saw as the shroud of secrecy around the House’s bill, which, at the time, he called an “Obamacare lite approach.”  

Paul has been noticeably more silent as the Senate holds closed-door meetings on healthcare.

But that doesn’t mean he supports the direction the bill is heading.

Speaking to a small group of reporters on Thursday, he said the bill looked like it was creating “new entitlements” in the form of a refundable tax credit that helps people better afford health insurance, and a pot of money aimed at stabilizing the market. Both provisions are likely to make the final Senate healthcare bill.

Asked if he would vote against it, Paul said “What I’m telling them is if they get to an impasse, come talk to me, because I’m more than willing to vote for a partial repeal if I can’t get complete repeal, but I’m not willing to vote for new Republican entitlement programs.”

Sen. Ted Cruz (Texas)

If there was an award for ObamaCare’s biggest foe, it would probably have gone to Cruz. But he’s looking less like the flamethrower who shut down the government over ObamaCare and more like a senator looking to get to “yes.”

For two months, Cruz gathered conservatives and moderates into his conference room to discuss healthcare once a week, meetings which, at the time, were kept secret from the press, Bloomberg reported and The Hill confirmed.

If leadership loses conservatives Paul and Lee, they’ll have to get Cruz to get on board.

So far, Cruz has only offered praise for the process and its outcomes. “One of the reasons I believe the discussions in the Senate are productive is the conversation has focused on how do we lower premiums,” he told reporters Monday.

He later said: “One of the reasons this process has worked well is you have not had senators drawing lines in the sand and litigating specific pieces of policy in public and through the press.”

Sen. Lisa Murkowski (Alaska)

On Thursday, Murkowski’s comments on healthcare didn’t sound good for leadership.

When asked if she had confidence she could eventually support a bill, Murkowski said she didn’t know.

She also wouldn’t commit to supporting a phase-out of Medicaid expansion’s enhanced federal funds, even if it was a seven-years long transition supported by other moderate members. She also wouldn’t say if she supported a faster or slower phase-out.

“My position on Medicaid expansion and my support for it hasn’t changed,” Murkowski said.

Previously, Murkowski said she wouldn’t vote to eliminate Medicaid expansions dollars if the Alaska Legislature wanted to keep them and wouldn’t vote to defund Planned Parenthood (which the House bill does).

Sen. Susan Collins (Maine)

Collins is one of the most moderate members of the Senate Republican conference — and leadership will really need to retain her vote if two conservatives oppose the bill.  

She voted against the reconciliation bill President Obama vetoed in 2016 because she couldn’t support defunding Planned Parenthood. Last month, she reiterated her uneasiness with the concept.

“It’s not the only issue in this huge bill. But I certainly think it’s not fair and it is a mistake to defund Planned Parenthood,” Collins said last month on ABC’s This Week.

In general, Collins has sounded an optimistic note.

“The Republican leader has given us an outline of the Senate bill and it is clear that it is far superior to the House bill,” she said Monday, “but we obviously don’t know the details, and the details really matter when you’re talking about healthcare reform.”

Sen. Dean Heller (Nev.)

Heller is facing one of the toughest reelection campaigns in 2018.

It’s easy to imagine the attack ads he’ll get if he votes for a bill resulting in Nevadans losing their health insurance. But if he opposes the measure, conservative groups are sure to flog him for failing to live up to the Republicans promise to repeal-and-replace ObamaCare.

It’s hard to predict what Heller will do.

Nevada is a Medicaid expansion state, and Heller favors a seven-year phase out of ObamaCare’s extra federal funds. This contrasts with Nevada Gov. Brian Sandoval (R), who wants to keep the Medicaid expansion.  

Additionally, Heller recently said he doesn’t like the controversial waivers included in the House bill to get hardline conservatives on board.

The waivers let states opt out of core ObamaCare insurance provisions, such as requiring insurers to cover a list of services and preventing carriers from charging sick people more money. The Senate might let states opt out of the essential health benefits but not community rating.

Sens. Rob Portman (Ohio) and Shelley Moore Capito (W.Va.)

Both Portman and Capito come from Medicaid expansion states that have been some of the hardest hit by the opioid epidemic.

The two have proposed phasing out enhanced federal funds for Medicaid expansion over a seven-year period, starting in 2020. Leadership has proposed a three-year transition.

To win over Portman and Capito, leadership might need to offer some sort of compromise.

Both will probably want more money to help curb the opioid epidemic, particularly as Medicaid is the single largest payer for behavioral health services, such as substance use disorder treatment. Senators are examining providing $45 billion over 10 years for opioids, Capito has said.