Republicans are one step closer to making good on their seven-year-long promise to repeal and replace Obamacare now that Senate Republicans have released their draft health care bill. But Republican Senators on both sides of the aisle are speaking out against it, with one side saying it's too conservative, and the other saying it keeps too much of President Obama's signature health care law intact. Republicans can only pass their health care bill by securing 50 votes (instead of the usual 60) due to a parliamentary maneuver called budget reconciliation, which would eliminate the threat of a democratic filibuster and keep the bill from seeing more than 20 hours of debate.
With little more than a week before the Senate breaks for a week-long recess over the July 4 holiday, Senate Majority Leader Mitch McConnell can only afford to lose two votes from his party and still pass the bill, provided Vice President Mike Pence casts the tie-breaking vote in favor of Republicans. As the tug-of-war between the party's far right and center take hold, Senate Republicans must get the votes or risk defaulting on the core campaign promise that put many of them in office in the first place.
Here are the nine Republican Senators who could tank their party's health care bill and why they're likely to stand in its way:
Ted Cruz, R-Texas
The Texas Republican is one of the most conservative members of the Senate, and also within the 13-person working group headed by McConnell to draft the senate health care legislation. Along with Sens. Mike Lee of Utah, Ron Johnson of Wisconsin, and Rand Paul of Kentucky, Cruz has made clear he is not ready to support the bill, known as the Better Care Reconciliation Act of 2017, in its current form.
Cruz, Johnson, Lee and Paul said Thursday in a statement:
Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor. There are provisions in this draft that represent an improvement to our current healthcare system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs.
During a February 2016 presidential debate, Cruz pledged to "repeal every word of Obamacare" while supporting the law's prohibition against denying coverage to people with pre-existing conditions. That provision, which is one of the most popular under Obama's health care law, is essentially made possible by the mandate that requires all Americans to have insurance, which the senate bill would scrap.
Ron Johnson, R-Wisconsin
Sen. Ron Johnson made no bones about breaking with party leader and fellow Wisconsinite Paul Ryan by decrying the House of Representative's first attempt at passing a health care bill last March, telling a statewide news site "I’ve got a lot of problems with the House bill as it’s written right now" days before its public failure stung the White House. Johnson then told press he didn't think Congress would be able to pass a bill to replace Obamacare in 2017 "because it’s really hard. We are seven years into the implementation of Obamacare. … You don’t undo that harm with a simple stroke of the pen on a simple ‘repeal and replace.'"
Mike Lee, R-Utah
Arguably the most conservative member of the Senate, Utah's Mike Lee is also a member of the working group that drafted the legislation and like Cruz, is threatening not to back it. He made waves earlier this week when he vented his frustration at Republicans' secretive drafting process, admitting he hadn't seen the bill, either. He's been an advocate of repealing Obamacare in full and with Cruz, Johnson, and Paul, could successfully lobby Republicans to bring the legislation further to the right, thereby alienating party moderates to his left.
Rand Paul, R-Kentucky
Along with Cruz, Paul is willing to test the boundaries of budget reconciliation, the process by which Republicans can scrape their bill through the Senate with a simple majority instead of the 60 votes usually required for passage. While most lawmakers believe that strategy will work as long as each provision in the bill directly impacts the budget, Paul is pushing to leave a lot more leeway to Vice President Mike Pence, who presides as President of the Senate and is sure to advocate in favor of far-right Republicans.
Susan Collins, R-Maine
Far to the left of Sens. Cruz, Johnson, Lee and Paul is Maine's Susan Collins, the most moderate member of the senate's Republican caucus. Along with Alaska's Lisa Murkowski, Collins is most likely to oppose the bill if lawmakers bring the legislation more in line with the demands of its far-right contingent. Collins and Lousiana Republican Sen. Bill Cassidy, a physician, have offered their own Obamacare alternative geared toward maintaining affordable care for older and lower-income Americans.
Lisa Murkowski, R-Alaska
Like Paul, Alaska Sen. Lisa Murkowski hails from a state that both went for Trump by a double-digit margin in 2016 and expanded Medicaid under Obamacare. The current senate bill, which proposes cutting Medicaid by billions of dollars in order to deliver hefty tax cuts to the most affluent residents, leaves her vulnerable to voter backlash.
Dean Heller, R-Nevada
Nevada Sen. Dean Heller is the most vulnerable Republican senator up for re-election in 2018, and while a vote against the bill could cost him party support and fundraising dollars ahead of next year's midterms, a vote for it could send Nevadans' health care costs skyrocketing and support within his voter base tumbling.
Shelly Moore Capito, R-West Virginia
Like Heller, West Virginia's Shelly Moore Capito hails from a state that expanded Medicaid under President Obama. Nearly two-thirds of Americans in nursing homes are covered by the entitlement program, along with 40 percent of American children and 20 percent of people nationwide. Expanded eligibility under Obamacare has provided insurance to more than 11 million previously uninsured Americans.
The senate draft bill would continue Obamacare's Medicaid expansion program until 2021, then phase it out over the course of three years. Capito is lobbying for a more gradual reduction of federal payments.
Rob Portman, R-Ohio
Capito and Ohio Sen. Rob Portman might be wooed toward supporting the draft legislation if it's accompanied by more federal dollars to combat the opioid addiction crisis, which resonates with voters back home. Portman told the New York Times that the bill must include opioid funding to get his vote:
Any replacement is going to have to do something to address this opioid crisis that is gripping our country.
It's likely to be a popular demand among fellow Republican Sens. Susan Collins and John Barrasso of Wyoming, as well as Democrats Bob Casey of Pennsylvania and Joe Manchin of West Virginia.