Health care bill could hinge on these 9 senators

WASHINGTON — Senate Republicans have been working behind closed doors for weeks on their plan to repeal and replace Obamacare.

But not all GOP senators like the emerging legislation — which will be unveiled Thursday — and Senate leaders can’t afford to lose more than a couple lawmakers when they vote, likely next week.

The most conservative senators want a quicker, more decisive end to the Affordable Care Act. Those from centrist states prefer a slower unraveling — preferring to keep Obamacare’s federal funding that allowed them to expand Medicaid to more residents.

With a slim 52-seat majority and staunch Democratic opposition, GOP leaders can afford to lose just two Republican senators and still pass the bill. Even then, they would need Vice President Mike Pence for the tie-breaking vote.

Here are nine senators to watch:

The hard-liners

Sen. Rand Paul The libertarian-leaning Kentucky senator dismisses GOP replacement proposals as Obamacare-lite, criticizing them as failing to keep the Republican promise of fully repealing the Affordable Care Act. Paul wants to gut the Medicaid expansion and do away with federal subsidies to help lower-income Americans afford private insurance on the Obamacare marketplace. Paul remains open to his colleagues’ ideas. But he is the conservative senator most likely to vote no. Sen. Ted Cruz A self-appointed go-between for Senate Republicans and conservatives in the House Freedom Caucus, the firebrand Texan has inserted himself in almost every aspect of the health care negotiations. Cruz shares the concerns of conservatives who argue the emerging GOP approach is not a full repeal. Up for re-election this fall, he is likely to vote for the Republican bill as he works to refashion his image as a leader. Sen. Mike Lee The quiet Utahan, often seen as the conservative conscience of the Senate, shares worries that the emerging GOP approach is not sufficient in undoing the ACA. He is more likely to join his colleagues to support the bill than be the one to tank it.

The keepers

Sen. Rob Portman Ohio has 680,000 additional residents receiving insurance though Medicaid thanks to the state’s decision to take the federal funding offered to expand its safety net health care program. Preventing those Ohioans from losing their insurance is a key goal for the senator. Portman has signaled a willingness to curtail the program, just not right away. Still, Portman is likely to vote for the bill, especially if adjustments are made for his state.

Sen. Shelley Moore Capito

Residents in rural West Virginia are also deeply reliant on Medicaid, which has expanded under Obamacare to provide care for an additional 180,000 residents, according to the Kaiser Family Foundation. Capito must balance her state’s robust support for Trump with the fallout that would likely come from cutting residents off Medicaid. She, too, prefers a slower phaseout. Still, Capito is a newer senator not known for bucking leadership, and may be inclined to join her colleagues to pass the bill.

Sen. Dean Heller

Heller is one of the most endangered senators up for re-election in 2018. The swing state of Nevada also expanded its Medicaid enrollment. Heller is pushing for a longer transition period away from Medicaid — seven or even 10 years. But that seems unlikely. The question will be whether Heller can settle for a sooner end to the program or if he is willing to risk angering Trump supporters with a no vote. Sen. Lisa Murkowski The Frontier State senator wants to ensure Medicaid funding for residents, whose health care costs run high in part because of Alaska’s expanse and isolation. Murkowski has an independent streak and has been known to part ways with leadership. GOP leaders will likely need to strike a deal to earn her vote.

The fixers

Sen. Bill Cassidy A physician who has spent a career caring for poorer patients, Cassidy has been at the forefront of trying to improve Obamacare with his own bill. He is conservative, but wary of rolling back the Medicaid expansion that his state of Louisiana began in 2016. Cassidy told reporters recently he was encouraged by negotiations with his Senate colleagues. Despite his early concerns, he will likely be supportive of the Senate effort. Sen. Susan Collins The Mainer is the most centrist Republican in the Senate and was an early backer of Cassidy’s efforts to repair, rather than gut, Obamacare. Often a political outlier in her party, she remains a team player. Once a highly sought-after vote when Democrats approved Obamacare, she ultimately joined all Republicans in opposing it. Her vote will be crucial.