Thursday’s House vote to repeal and replace ObamaCare puts Sen. Dean Heller (R-Nev.) in the hot seat.
The House GOP’s American Health Care Act (AHCA) would largely eliminate ObamaCare’s Medicaid expansion, which has enrolled hundreds of thousands of Nevadans since 2013.
Heller, seen as the most vulnerable GOP senator up for reelection after his state backed Democratic presidential nominee Hillary Clinton and freshman Sen. Catherine Cortez Masto (D-Nev.) in 2016, quickly distanced himself from the current version of the bill.
But Heller is stuck in a bind between a conservative base that’s long been promised ObamaCare repeal and more moderate voters who could exact political revenge if he helps roll back ObamaCare and its Medicaid expansion.
“I would be very concerned simply because of the environment we’re walking into,” a Western GOP political consultant said when asked about Heller’s race. “It’s a lot of time between now and Election Day, but I would certainly be gearing up now.”
The GOP’s healthcare reform push has already inspired new energy on the left, and last week’s House vote could become one of the defining issues of the 2018 midterms.
That would put Republicans in districts or states carried by Clinton in an especially tough position. The party campaigned for seven years on repealing ObamaCare, but it now finds itself divided between conservatives and more moderate lawmakers on the details of the party’s new plan.
A number of Republican senators, particularly those from states that accepted the Medicaid expansion, have already expressed concerns about both the AHCA’s Medicaid cut and its offer for states to waive ObamaCare requirements on pre-existing conditions, provisions that helped win votes from the conservative House Freedom Caucus.
Concerns from moderate Republican senators means the bill is likely dead on arrival in the Senate. Instead, senators are expected to write their own version.
The House bill would roll back ObamaCare’s Medicaid expansion with cuts totaling $880 billion over 10 years, which is expected to reduce enrollment as states prove unable to fund the expansion themselves and current recipients leave the program.
Heller, the only GOP senator up for reelection in a state Clinton won, immediately drew a line in the sand by coming out against the bill hours after it passed the House.
“We cannot pull the rug out from under states like Nevada that expanded Medicaid and we need assurances that people with pre-existing conditions will be protected,” he said in a statement hours after the bill passed.
That proactive response differs from his strategy during the initial healthcare push. In March, Heller kept silent on an earlier version of the bill before finally coming out against it shortly before it was pulled from a vote in the House over GOP opposition.
But while this new strategy of vocal opposition could help distance Heller from the unpopular House bill, Democrats want to hang the plan around his neck anyway.
Minutes after the vote, the Democratic Senatorial Campaign Committee (DSCC) purchased YouTube ads targeting Heller and Arizona Sen. Jeff Flake, another GOP senator who is seen as a potential target for Democrats.
“Every day until Election Day of 2018, we will hold Dean Heller accountable for his toxic healthcare plan that strips coverage away from those with pre-existing conditions, makes older Americans pay five times more for care and puts the interests of the rich and powerful over the interests of Nevadans,” DSCC spokesman David Bergstein told The Hill.
Hoping to tie Heller to the plan, Democrats point to leaked audio from a private luncheon last month in Nevada. In the recording, Heller said that he wants to “do everything I can to get to a yes” on the healthcare bill.
If Heller opposes the plan too loudly, he’ll expose himself to a primary election challenge. But if he’s seen as too close to it, he’ll lose the moderates who backed Clinton in 2016.
And while Democrats are rallying opponents of the healthcare bill across the country, Heller angered some of his base with recent comments about Planned Parenthood.
At a rowdy town hall last month, Heller said he opposed blocking Planned Parenthood from receiving federal funds, an important issue for anti-abortion voters. His spokeswoman walked back the comments the next day.
“He’s upsetting his base and the moderate, independent voters. That’s not a safe place for him to be in a state that voted for Hillary Clinton and a Democratic senator,” a Democratic strategist involved in Senate races told The Hill. “There’s going to be an incredible amount of pressure coming to bear on him.”
While Democrats want to use the House bill against Heller, the Senate’s push to rewrite the bill will likely help distance him from the unpopular House version. If Senate Republicans can’t agree on their own version, Heller could be stuck.
But if lawmakers pass a more palatable bill with protections for the Medicaid expansion, especially with Heller’s help, he stands to gain.
Plus, Heller has the support of Nevada Gov. Brian Sandoval (R), who said he remains opposed to the House’s bill and will continue to “stand” with Heller.
On the other hand, Rep. Mark Amodei, the only Republican in the state’s congressional delegation, voted for the bill.
Part of the aggressive push from Democrats comes from the contours of the Senate map in 2018. Republicans will largely be on offense, only needing to defend eight seats, while Democrats will have 25 seats on the ballot.
Ten of those Democratic seats are in states Trump won, often by double-digit margins. If Democrats are going to offset losses elsewhere, they need to take Heller’s seat.
No primary challengers have emerged yet to confront Heller, and most believe a serious one is unlikely. Meanwhile, a few Democrats are weighing bids, but none have officially jumped entered the race.
Rep. Dina Titus (D-Nev.), who’s considering a bid, said she’s spoken about it with some people but will run for reelection if she passes on it. Titus ran for governor in 2006.
Former Nevada State Treasurer Kate Marshall, who reportedly has the backing of Cortez Masto, the junior senator, is also weighing a run. She’s previously run unsuccessfully for a House seat and for Nevada secretary of State.
While the fate of the GOP’s ObamaCare replacement bill remains uncertain, Democrats will continue to keep their foot on the gas on healthcare.
“This is now [Republicans’] problem,” said Jim Manley, who served as an aide to former Sen. Harry Reid (D-Nev.). “They are the ones taking away healthcare… and Sen. Heller belongs to that party.”