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The ‘Resistance’ Lost On Health Care In The House. Can It Win In The Senate?

At a press conference on Friday, U.S. Sen. Dean Heller of Nevada, a Republican, sharply criticized the Senate version of Obamacare repeal, arguing that it “takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans” and that “there is nothing in this bill that will lower premiums.” He called the idea that the legislation would reduce health care premiums for some Americans a “lie.”

“It’s going to be very difficult to get me to a yes,” he added.

Heller’s comments — particularly the sharpness of his opposition — were something of a surprise, because he had not been particularly vocal about Obamacare before. And while this is impossible to prove, it’s likely that the aggressive liberal organizing against the Obamacare repeal, both nationally and in Nevada, even before the formal release of the GOP’s Senate health care bill, helped move Heller against it. After all, Heller is perhaps the GOP senator most susceptible to liberal political pressure, because he is the only Republican in the chamber up for re-election next year in a state where Hillary Clinton won (by 2.4 percentage points) in November.

So now one of the big questions as this health care debate continues will be if the liberal “resistance” to Trump can keep Heller in the “no” column on the Obamacare repeal. He may have sounded firmly against the bill, but the last time the resistance was in this position on health care, they lost.

The intense liberal opposition to President Trump has had some clear successes during the five months of his presidency. The women’s marches, a day after Trump’s inauguration, drew huge crowds and were a visible illustration that the president would not get the honeymoon period that his predecessors had. People rushed to airports to protest Trump’s travel ban, which helped turn that controversial policy into a media frenzy. Angry liberals calling into the offices of Senate Democrats appeared to push the senators left and get them to start opposing Trump’s Cabinet nominees en masse. And throughout the year, even more moderate Democrats, such as Sen. Joe Manchin of West Virginia, have largely stuck with the party and opposed Trump’s key initiatives. For example, no House Democrats voted for the Obamacare repeal in that chamber, and all Democrats in the Senate are expected to oppose the Senate version of the legislation.

But on health care, the resistance, while heavily mobilized, had a clear loss: The House passed an Obamacare repeal in May.

And that defeat included the defections of members of Congress who sounded like Heller on Friday — until they didn’t. In March, on the eve of an expected vote on the House version of Obamacare repeal, GOP Rep. Rodney Frelinghuysen of New Jersey said he couldn’t support the legislation, as he worried about the “loss of Medicaid coverage for so many people in my Medicaid-dependent state.” Frelinghuysen is in a state where Clinton won (Trump carried Frelinghuysen’s district but by less than 1 percentage point), and there had been strong liberal organizing in his district against the bill.

But on May 4, he voted for an updated version of the American Health Care Act that had very similar Medicaid provisions. Similarly, Florida Rep. Carlos Curbelo, a Republican who represents a district Clinton won by 16 percentage points, said he was leery of the March version of the House Obamacare repeal but voted for the arguably more conservative version in May.

Republicans in blue and purple districts backed the AHCA

How House Republicans who represent districts where Clinton won in 2016 or lost by less than 5 points voted on the American Health Care Act

Ileana Ros-Lehtinen FL-27 -19.7
Carlos Curbelo FL-26 -16.1
David Valadao CA-21 -15.5
Barbara Comstock VA-10 -10.0
Erik Paulsen MN-3 -9.4
Mike Coffman CO-6 -8.9
Ed Royce CA-39 -8.6
Darrell Issa CA-49 -7.5
Peter Roskam IL-6 -7.0
Steve Knight CA-25 -6.7
Mimi Walters CA-45 -5.4
Martha McSally AZ-2 -4.9
John Katko NY-24 -3.6
Will Hurd TX-23 -3.4
Jeff Denham CA-10 -3.0
Dave Reichert WA-8 -3.0
Patrick Meehan PA-7 -2.3
Pete Sessions TX-32 -1.9
Dana Rohrabacher CA-48 -1.7
John Culberson TX-7 -1.4
Kevin Yoder KS-3 -1.2
Leonard Lance NJ-7 -1.1
Ryan Costello PA-6 -0.6
Brian Fitzpatrick PA-8 +0.2
Rodney Frelinghuysen NJ-11 +0.9
Jason Lewis MN-2 +1.2
Mario Diaz-Balart FL-25 +1.7
Don Bacon NE-2 +2.2
Scott Taylor VA-2 +3.4
Rod Blum IA-1 +3.5
David Young IA-3 +3.5
Randy Hultgren IL-14 +3.9
Dave Trott MI-11 +4.4
Frank LoBiondo NJ-2 +4.6

Sources: Clerk of the U.S. House, Daily Kos Elections

Heller could change his mind, too, as there is some evidence that he wants to see Obamacare rolled back. At a closed-door meeting of conservatives in April that was secretly recorded by a Democratic operative, Heller said, “I will do everything I can to get to a yes” on Obamacare repeal. And Heller has never appeared particularly liberal on health care, or overall. In fact, according to FiveThirtyEight’s Trump plus/minus rating, which measures how often a member votes with Trump compared to the politics of his or her district or state, Heller ranks second among GOP senators in taking the Trump position on key issues more often than expected. (The Trump position is nearly always that of the Republican leadership in the Senate.)

Which GOP senators vote with Trump more than expected?

How often each senator votes in line with President Trump’s position on bills (Trump score) compared to what’s expected based on the political lean of their state

Cory Gardner CO 95.3% 43.9% +51.5
Dean Heller NV 93.0 49.2 +43.9
Ron Johnson WI 97.7 56.4 +41.3
Marco Rubio FL 97.7 57.4 +40.3
Patrick J. Toomey PA 95.2 56.2 +39.0
Susan M. Collins ME 86.0 48.0 +38.1
Richard Burr NC 97.7 62.9 +34.7
Thom Tillis NC 97.7 62.9 +34.7
Jeff Flake AZ 95.1 62.3 +32.8
David Perdue GA 97.6 65.4 +32.2
Johnny Isakson GA 96.3 65.4 +30.9
John McCain AZ 90.5 63.0 +27.5
John Cornyn TX 97.7 73.8 +23.9
Rob Portman OH 95.3 72.2 +23.2
Ted Cruz TX 95.3 73.8 +21.6
Joni Ernst IA 95.3 74.5 +20.8
Chuck Grassley IA 95.3 74.5 +20.8
Dan Sullivan AK 97.6 82.6 +15.0
Tim Scott SC 95.3 82.0 +13.3
Thad Cochran MS 97.7 86.2 +11.5
Roger F. Wicker MS 97.7 86.4 +11.3
Orrin G. Hatch UT 93.0 82.0 +11.0
Lindsey Graham SC 97.7 87.0 +10.7
Roy Blunt MO 92.9 82.3 +10.6
Lisa Murkowski AK 97.7 87.9 +9.8
Bill Cassidy LA 97.6 88.5 +9.1
Jerry Moran KS 95.3 87.9 +7.4
Pat Roberts KS 95.3 88.6 +6.7
Mike Lee UT 97.6 92.0 +5.6
John Kennedy LA 93.0 87.5 +5.5
Steve Daines MT 97.7 92.8 +4.9
Lamar Alexander TN 97.6 93.8 +3.8
Todd Young IN 97.7 93.9 +3.8
John Boozman AR 97.7 93.9 +3.8
Richard C. Shelby AL 95.3 91.8 +3.5
Mitch McConnell KY 95.3 92.8 +2.5
Mike Rounds SD 97.7 95.5 +2.2
John Thune SD 97.7 95.6 +2.1
Deb Fischer NE 97.7 95.6 +2.1
Ben Sasse NE 93.5 91.7 +1.8
Tom Cotton AR 97.6 96.2 +1.4
John Hoeven ND 97.7 96.5 +1.2
James M. Inhofe OK 97.7 96.5 +1.2
Michael B. Enzi WY 97.7 96.5 +1.2
James Lankford OK 95.3 94.6 +0.7
Luther Strange AL 95.3 94.6 +0.7
Mike Crapo ID 95.3 94.6 +0.7
James E. Risch ID 95.3 94.6 +0.7
Shelley Moore Capito WV 90.5 92.2 -1.7
Bob Corker TN 90.5 92.2 -1.7
John Barrasso WY 87.8 94.0 -6.2
Rand Paul KY 87.8 94.0 -6.2

In other words, Heller is pretty conservative considering how blue his state is.

On Friday, he said he opposed the Senate bill “in this form.” There are likely to be revisions, although it’s not clear if those changes will be made to appeal to the concerns of more moderate Republicans like Heller or conservatives such as Rand Paul of Kentucky, who feels the bill does not repeal enough of the original Affordable Care Act.

And Heller is now about to feel political pressure from the right, too: A pro-Trump group called “America First Policies” is considering running digital, radio and TV ads demanding that Heller back the Obamacare repeal bill. A day after Heller’s press conference, American First was already going after him:

Hugh Hewitt, an influential conservative radio talk show host, blasted the Nevada senator as a “hollow man” and warned that Republican voters will abandon Heller next year if he prevents Obamacare’s repeal. Trump himself appears to be leaning on reluctant Republicans and trying to tie the Obamacare repeal to the broader struggles of the Affordable Care Act’s state-based markets.

“I cannot imagine that these very fine Republican senators would allow the American people to suffer a broken ObamaCare any longer,” he said on social media Saturday.

So, to keep Heller opposed to this legislation, liberal organizers say they will keep pushing him. The liberal group Indivisible Project has named a “Trumpcare Ten,” a bloc of GOP senators it views as most likely to oppose the legislation. The group is urging its members to contact these senators and has set up an online tool for users to send an email to Heller’s chief of staff, deputy chief of staff and main health-care staffer. Nevada activists from groups such as Planned Parenthood will hold a protest outside of Heller’s Reno office on Thursday.

“We don’t plan on pulling back until Sen. Heller actually votes no,” said Laura Martin, associate director of the Progressive Leadership Alliance of Nevada. “The fact that he said ‘as written’ when talking about his vote … shows he is open to voting ‘yes’ on a very, very bad bill.” She added: “We have said from the beginning Congress needs to find ways to expand coverage, not take it away. We will keep calling, visiting his office, educating Nevadans and supporting Nevadans on Medicaid as they share their personal stories until a vote is taken or the bill is shelved.”

Heller has three other potential challenges to getting to a “yes” vote that are in some ways outside of the liberal resistance. First, Republican Gov. Brian Sandoval of Nevada has been strongly defending the Medicaid expansion and saying it is vital to the state. Second, the AARP is running ads in Nevada against the repeal. AARP is not traditionally liberal but strongly dislikes this bill, feeling it hurts the elderly. And finally, the electoral stakes of Heller’s decision on health care are more immediate now: He’s drawn a serious opponent in his 2018 re-election bid, Nevada Rep. Jacky Rosen, a Democrat, who announced last week that she will run against him. If he votes “yes” on health care and Nevada voters don’t like it, they have a viable alternative.

Heller’s vote is significant, since three Republicans can kill the Obamacare repeal effort. But how he positions his opposition is also important. His early stance, casting the bill as not reducing premium costs and being too aggressive in cutting Medicaid, is hard to reconcile with the concerns of Paul and Sen. Ted Cruz of Texas. If liberal activists can keep Heller in effect defending the bill with Democratic-style rhetoric, that will make it hard for GOP Senate leaders to make changes that would accommodate him that don’t irritate more conservative Republicans. If Heller continues to sound like he did on Friday, that will be a huge victory for the liberal resistance and potentially torpedo the Obamacare repeal effort.

Perry Bacon Jr. was a senior writer for FiveThirtyEight.