When senators come back to Washington on Monday, a handful of Republicans will help decide the fate of legislation that could reshape health care in America.
One of them is Nevada Republican Dean Heller.
Sen. Heller is one of a small bunch of Republicans who have said they will not support the latest draft proposal to repeal and replace the Affordable Care Act, or Obamacare. Republican leadership can only lose the support of two of its own senators and still pass such a bill.
The Republican senators who say they’ll vote no on the latest health care plan fall into two camps. Members of the party’s right wing think this proposal is too timid and doesn’t go far enough to undo the Affordable Care Act. More moderate Republicans, like Heller, think it is harsh and goes too far.
“I’m telling you right now, I cannot support a piece of legislation that takes away insurance away from tens of millions of Americans and hundreds of thousands of Nevadans,” he said.
Nevada’s popular governor, Brian Sandoval, was the first Republican governor in the country to expand Medicaid under the Affordable Care Act. More than 200,000 uninsured people got coverage after the expansion.
With that expansion of coverage, many people here are watching the fate of this bill to learn whether they’ll be able to keep going to the doctor.
Heller’s position has prompted advocacy groups and constituents on both sides of the issue to flood his office with calls.
For weeks, protesters have been showing up outside the senator’s Las Vegas office urging him to oppose any changes to the health care system that would roll back provisions like the Medicaid expansion or funding for Planned Parenthood.
Cyndy Hernandez, who helped organize the most recent protest, says Heller’s opposition to the bill GOP leadership is crafting isn’t necessarily a done deal — “not until he marks that button on his desk in the Senate chamber.”
Patients at FirstMed clinic, where 80 percent of the patients are on Medicaid, voice their concern on a daily basis, nurse Maria Vital says. Administrators say the clinic would be forced to close without the funding it gets through the Affordable Care Act. Many of these patients went years without seeing a doctor for easily treatable conditions before the clinic opened, Vital says.
“They’re very scared,” she says. “They’re asking us what will happen to them, and I tell them we will try to be here as long as we can for them.”
Across town in Henderson, Taylor Lewis lives with her 7-year-old daughter Riley in a modest condo, with a couple of dogs and a large collection of plastic toy dinosaurs. Riley whispers their names as she pulls each one out of a big paper bag: stegosaurus, pterodactyl, Tyrannosaurus rex.
Ten days after Riley was born, a helicopter rushed her to the hospital for emergency heart surgery. When Taylor got over the shock of her daughter’s near-death, she got another shock. The helivac bill totaled $20,000.
On top of being a single mom, Taylor has been working part time and studying part time — she just finished her master’s in public health.
Until she finds a full-time job, she depends on Medicaid to cover all of her daughter’s medical costs.
She sometimes thinks about what her life would be like if Nevada had not expanded Medicaid coverage.
“I mean, I’d be without anything. I’d be without a car, a house,” Taylor says.
For people on both sides of this debate, the stakes seem far higher than a typical piece of legislation.
People like Taylor feel that what has been proposed puts their lives on the line; Republicans who support the bill see a chance for lawmakers like Heller to keep a promise that Republicans have made in every campaign for nearly a decade.
Conservative talk radio host Wayne Allyn Root says nearly every caller now talks about voting Heller out of office because of his opposition to the draft proposal that Republicans floated in recent weeks.
“If Heller votes no on the repeal he’s got to go, you gotta primary him,” he says.
Root broadcasts out of his home studio for three hours each day. He has piles of framed photographs, including images of him with President Trump, Newt Gingrich and Ronald Reagan.
Root says his listeners are aghast that a Republican senator from their own state could be responsible for helping to kill this bill.
National groups on both sides have put millions of dollars into TV ads trying to sway Heller. The senator is home for the July Fourth recess this week, but he isn’t spending that time holding town halls.
In the small town of Ely, he rode a horse in the July Fourth parade. He watched the fireworks in Elko, another town in rural northern Nevada. Even there, some people heckled him.
Heller declined the Republican Party’s invitation to march in the town of Pahrump, which has the same spectrum of Republican views that’s dividing the Senate.
Local party chairman Joe Burdzinski thinks the bill is too timid. He’d stand with senators like Rand Paul and Ted Cruz, holding out for a full repeal.
“The Republican Party has said for the last eight years we’re gonna repeal and get rid of Obamacare. That’s what Donald Trump said he wanted to do, that’s what other Republicans running for office have said. Now they have to live up to that commitment to the American people because … the American people voted for that,” he says.
Leo Blundo, another official with the Nye County Republican Central Committee, has more sympathy for Sen. Heller, but doesn’t quite believe Republican leaders who say this is the only train leaving the station.
“It’s public knowledge we got both houses [of Congress],” he says. “Get some business done. … Quit mickey-mousing around and get some work done.”
For Heller, the considerations about Medicaid expansion and repeal promises might all take a back seat to a more pressing reality. He’s up for re-election next year — a Republican in a state that has gone blue for the last three presidential elections.
Whatever position he takes on the final bill, that race will be far from an easy win.