Healthcare issue delivers nothing but pain for Nevada's embattled Sen. Dean Heller

Dean Heller is Stephanie Diaz-Gonzalez’s problem now.

She’s never met Nevada’s Republican senator and hadn’t had much time to familiarize herself. How could she? The 25-year-old is holding down a full-time job and raising a 7-year-old son, who keeps her busy with soccer games, math homework and those too-often terrifying moments when he can’t breathe.

“It’s a moment of desperation,” she said. “All anxiety. Everything focuses to that one thought and do what any mother would do. It was worse when I knew I only had one inhaler, though.”

Her son, Josiah, has asthma. So does she. Before Nevada Gov. Brian Sandoval expanded Medicaid under the Affordable Care Act — Obamacare — she couldn’t afford the refills for their inhalers. So she would give him hers. At $140 per refill, the cost was prohibitive.

Then she got coverage. The refills dropped to $25. Suddenly, she could breathe a sigh of relief because her son could literally breathe again.

When President Trump was elected and Congressional Republicans moved on their top priority to dismantle Obamacare, Diaz-Gonzalez got to know Heller a whole lot better.

Given his back-and-forth on the issue, she came to distrust him.

“I don’t know if I could vote for him or support him,” the Democrat said. “He seems very contradictory.”

Which is why Heller is also Karen Steelmon’s problem.

Steelmon, a 48-year-old Republican who grew up in northern Nevada, isn’t happy with the lawmaker, who is considered the most vulnerable GOP senator in the country when he comes up for re-election next year.

Obamacare has always been an abomination to Steelmon, an ardent supporter of repeal. To her, deeply held principles are at stake.

“Heller has never acted in favor of what I would consider conservative, constitutional principles as a general rule,” said Steelmon, who would like to see the incumbent taken out in a GOP primary. “And on the very few times he has, it’s always come as a surprise.”

This is Heller’s dilemma.

Despite a Republican constituency urging a repeal of Obamacare, he refused to back the Senate bill that Majority Leader Mitch McConnell wanted to vote on this week, joining a handful of other senators who forced a delay past the congressional Fourth of July recess. He was mindful the Medicaid expansion remains popular in Nevada, with its large population of service-industry and minimum-wage workers.

Heller has generally laid low since standing alongside Sandoval last week at a Las Vegas news conference, where he announced his opposition to the Senate bill in harsh, uncompromising terms. But he surfaced in a “tele-town hall meeting,” speaking to constituents Tuesday night from his office in Washington, and raved about the state’s Medicaid expansion and expressed “real consternation” about the millions nationwide who would lose coverage under the Senate plan.

“It’s going to be very difficult to get me to a yes,” Heller said, according to Nevada Independent editor Jon Ralston, who listened in on the call. Heller said it would take “an offer we can’t refuse, me and the governor.”

Sandoval, who appointed his friend Heller to the Senate in 2011 when the seat became vacant, was among the few Republican governors to embrace Medicaid expansion and has been a vocal critic of Obamacare repeal-and-replace efforts that would significantly undermine the decades-old program.

Heller is keenly aware of conservatives like Steelmon who won’t stand for anything less than abolishing Obama’s signature achievement.

The dynamic leaves Heller with no good options, and nowhere to hide.

He has the unique distinction of being the only Republican senator up for reelection in 2018 in a state Hillary Clinton carried, making him a prime Democratic target even before the healthcare issue surfaced. He's not in any position to duck the controversy.

“Medical issues are becoming ever more important in Nevada politics,” said Michael Green, a University of Nevada, Las Vegas, history professor and decades-long student of campaigns and elections. “The state has one of the top opioid problems in the country. It still has one of the largest 55-plus populations. The Medicaid expansion has been significant... to suddenly blow up Obamacare doesn't look very good for him.”

Nevada, once a Republican stronghold, has steadily moved away from the GOP over the past two decades, as a booming Latino population has gained political clout.

Although nowhere near as popular as Obama, Hillary Clinton still managed to carried the state over Trump 48% to 46% and provided enough momentum to help lift Democrat Catherine Cortez Masto into Nevada's other Senate seat, replacing retired Democratic leader Harry Reid. Democrats also won three of Nevada's four House seats and seized control of the Legislature.

State lawmakers, sensing the popularity of Obamacare in Nevada and worries about a Republican repeal in Congress, passed the nation’s first-ever Medicaid-for-all bill that would have given all of the state’s 2.9 million residents a crack at a Medicaid-style plan sold under the Silver State Health Insurance Exchange.

Sandoval vetoed the bill earlier this month, but offered constructive criticism while praising the bill’s Democratic sponsor for “creativity” and said the concepts laid out in the measure may play “a critical role in future health care policy.”

Nevada’s embrace of Medicaid expansion has been robust since Sandoval signed on in 2014. With about 600,000 people enrolled in Medicaid, about a third are covered. According to state figures, Nevada’s uninsured rate was 23% in 2012 — one of the highest in the country — and by 2015 had fallen to 11%.

While Sandoval remains highly popular, Heller has never enjoyed the same regard.

Diana Davis is another who doesn’t trust the state’s senior senator.

The 27-year-old Democrat has insurance now under the Medicaid expansion, but almost died from complications due to an enlarged thyroid. She dropped 20 pounds and had to have surgery. She also has a 3-year-old boy who was diagnosed with autism and needs the health insurance to get him therapy.

She said she sees Republicans’ opposition to Obamacare as not just a wall to her son’s future, but also a long-term cost to society.

“He just needs therapy because when they can fix the behavior, he pays attention better and listens better,” she said. “And that gives him a future to go into the general education system. That ultimately saves the government money in the long run.”

Green sees very little wiggle room for Heller, who has suggested he is open to negotiation provided the outcome does right by Nevada. “I think Heller has cemented himself on this issue,” Green said. “The only way he can get to ‘yes’ is for a very different bill.”

david.montero@latimes.com

Twitter: @davemontero

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