(Bloomberg) — GOP Sen. Dean Heller of Nevada said Friday he opposes Majority Leader Mitch McConnell's plan to overhaul parts of the Affordable Care Act, as the party leader faces pushback from fellow Republicans days before the Senate may begin debate on the measure.
"It's going to be very difficult to get me to yes," said Heller, viewed as the Senate Republican most at risk in the 2018 midterm election. He became the fifth senator to say he won't vote for the measure in its current form.
The Better Care Reconciliation Act proposal's cuts to Medicaid and subsidies for individual insurance coverage are too tough on Nevada residents, Heller said at a news conference with Nevada Gov. Brian Sandoval. Without significant changes in the proposal, the senator said he'll vote with Democrats to block it from reaching the Senate floor.
"I cannot support a piece of legislation that takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans," Heller said.
Sandoval, a Republican who accepted the ACA Medicaid expansion in his state, said about 210,000 people gained health coverage under the law. "They're living healthier and happier lives because of that decision," he said.
McConnell is working to get other GOP holdouts to back the health care bill for a possible vote next week, as he begins to separate those who can be won over with modest changes and those who may have unbridgeable concerns.
McConnell, a veteran Senate tactician, may have made some intentional omissions in the "discussion draft" he released so that senators can be seen securing public victories in return for their support. For example, the draft contains only $2 billion for opioid-related programs, a number that could easily be boosted to win over Midwestern Republicans.
But other gaps will be much harder to overcome, particularly with conservatives demanding more changes to the Affordable Care Act and moderates uneasy about the phaseout of the original law's Medicaid expansion.
Only a few hours after the bill was released, four conservatives led by Rand Paul of Kentucky announced they'll need a host of changes to get to "yes." Two moderates — Lisa Murkowski of Alaska and Susan Collins of Maine — said they want to remove the bill's one-year halt in funding for Planned Parenthood. Rob Portman of Ohio said it doesn't provide enough funds for the opioid epidemic.
"The fact we think this bill will spend more next year than Obamacare spends now, that doesn't sound like repeal," said Paul, who added that he will be negotiating as a team with fellow conservative holdouts Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah.
'Really Special!'
President Donald Trump backed the measure in a Twitter posting that said, "I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, Obamacare is dead."
Sen. John Cornyn, the No. 2 Republican leader, said he's still confident that at least 50 of the chamber's 52 Republicans will wind up supporting it in a vote likely to come early next Friday morning. That's the number needed to pass the bill with only 50 votes, along with the tie-breaking vote support of Vice President Mike Pence.
The plan released Thursday "is sort of a best guess of where the Republican conference is," Cornyn told reporters, adding that McConnell will massage its contents right up until when he introduces it as early as Tuesday. "But people have other things they want to see in the bill, and that's what we're working through."
GOP leaders made clear "this isn't a take-it-or-leave-it proposition," said Sen. Marco Rubio of Florida.
The new bill is intended to walk a delicate line in its relatively modest tweaks to the measure that passed the House last month.
