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With time running out, health care advocates look for GOP 'no' votes

There's an unsettled landscape, and even the most optimistic voices in Republican politics don't yet believe there are 51 votes for their health care bill.
Sen. Susan Collins, R-Maine, ranking Republican on the Senate Homeland Security and Governmental Affairs Committee walks to a meeting on Capitol Hill in Washington, Wednesday, Nov. 28, 2012, for a meeting with UN Ambassador Susan Rice. Rice continued...
Sen. Susan Collins, R-Maine, ranking Republican on the Senate Homeland Security and Governmental Affairs Committee walks to a meeting on Capitol Hill in...

Sen. Dean Heller (R-Nev.) didn't just announce his intention to vote against his party's health care plan late last week; he also torched the legislation itself. For all intents and purposes, the Nevada Republican's argument against the GOP bill wasn't much different from the Senate Democrats' case.

But one "no" vote among Senate Republicans won't be enough to rescue the American system from the proposal. Health care advocates will need two more GOP senators to break ranks.

Sen. Susan Collins (R-Maine) hasn't formally made an announcement, but her comments to ABC News' George Stephanopoulos yesterday suggested she isn't exactly ready to partner with her far-right colleagues.

"For my part, I'm very concerned about the cost of insurance for older people with serious chronic illnesses, and the impact of the Medicaid cuts on our state governments, the most vulnerable people in our society, and health care providers such as our rural hospitals and nursing home, most of whom are very dependent on the Medicaid program. So threading that needle is going to be extremely difficult. [...]"I'm also very concerned about the Medicaid cuts, what it means to our most vulnerable citizens. And I'm very concerned about the cost of insurance premiums and deductibles, particularly for that very vulnerable group between the age of 50 and 64. They are particularly at risk, based on my initial analysis."

Of particular interest, the Maine Republican, widely seen as the most moderate GOP senator, added that the Senate bill "is going to have more impact on the Medicaid program than even the House bill" -- and given that Collins opposed the House bill, this wasn't a compliment. Asked about the timeline her party's leaders have in mind, Collins added, "It's hard for me to see the bill passing this week."

Republican insiders continue to work from the assumption that "moderates always cave." Whether Collins will take this opportunity to prove them wrong remains to be seen, but let's not forget that the senator is rumored to be interested in a gubernatorial campaign next year. Voting for a wildly unpopular health care bill wouldn't exactly serve as a springboard for a statewide race.

But even if Collins joins Heller among the bill's opponents, that's still not enough to stop the regressive legislation. Who else is worth watching?

Sen. Rand Paul (R-Ky.): The Kentucky Republican has been deeply critical of the existing plan for several weeks, and though he gave mixed messages in an interview yesterday with George Stephanopoulos, Paul didn't sound at all supportive of his party's existing plan.

"Why don't we whittle it down to what the whole caucus agrees on?" he said. "I think there's a bill that all 52 Republicans agree on if they keep narrowing the focus. They've promised too much. They say they're going to fix health care and premiums are going to down. There's no way the Republican bill brings down premiums." He added that the current GOP plan invites a "death spiral," which has the benefit of being true.

Sen. Ron Johnson (R-Wis.): Though the Wisconsin lawmaker raised "concerns" last week, it's been widely assumed that he'd stick with his party when push came to shove. Yesterday, however, Johnson talked to NBC News' Chuck Todd on "Meet the Press," and said, "I would like to delay the thing. There's no way we should be voting on this next week. No way."

Asked about slowing down the process, the Republican lawmaker added, "I have a hard time believing Wisconsin constituents or even myself will have enough time to properly evaluate this, for me to vote for a motion to proceed." (Johnson also has a New York Times op-ed today, demanding that the legislation be pushed even further to the right.)

Sen. Bill Cassidy (R-La.): As of a few days ago, Cassidy was assumed to be a "yes" vote, but on CBS News' "Face the Nation" yesterday, he said, "I don't know quite why the rush. I frankly would like more days to consider this." He added, "Right now I am undecided. There are things in this bill that adversely affect my state, that are peculiar to my state. A couple of the things I am concerned about, but if those can be addressed I will. And if they can't be addressed, I won't."

To be sure, every time a Senate Republican raises "concerns," it should be taken with a grain of salt. Different members have different motivations, and many GOP lawmakers hope to extract some concessions ahead of Thursday's vote. Don't assume that every senator who sounds skeptical now intends to follow through with a "no" vote later this week.

That said, the chatter reflects an unsettled landscape, and even the most optimistic voices in Republican politics don't yet believe there are 51 votes for the bill.

FiveThirtyEight's Nate Silver noted over the weekend that the toughest votes for GOP leaders to get on health care are, in order, Nevada's Dean Heller, Maine's Susan Collins, Kentucky's Rand Paul, and Alaska's Lisa Murkowski, who had very little to say over the weekend.

That sounds about right to me, though I've gone back and forth on whether Paul and Murkowski should be flipped. Either way, health care advocates wouldn't need all four: three would be enough.