On Saturday afternoon, Mr. Trump posted on Twitter, venting about Mr. Heller and other Republicans who are not supporting the Senate bill.
On Friday, Mr. Sandoval acknowledged the obvious. âHeâs in the eye of the storm here,â Mr. Sandoval said at a news conference in Nevada as Mr. Heller stood next to him, looking vaguely miserable as Mr. Sandoval announced his opposition to the Senate bill. The legislation could affect 210,000 Nevada residents insured through the health care lawâs expansion of Medicaid.
On Friday Mr. Heller said that he, too, was against the bill as it is currently drafted, leaving himself just enough wiggle room to continue his longstanding practice of being the senator in the middle, the man who wants to see the Medicaid program phased out, except when he decides he doesnât. (Mr. Heller has taken both positions publicly.) He has also voted to take away money from Planned Parenthood, but tells some select audiences that âI have no problems with federal funding for Planned Parenthood.â
Mr. Heller, whose spokeswoman said he was not available for an interview, said at the news conference Friday that âthis bill thatâs currently in front of the United States Senate is not the answer â itâs simply not the answer.â He said, âItâs going to be very difficult to get me to a yes.â
As early as Thursday, the Senate will take a momentous vote to repeal the health law, and for Republicans from states that expanded their Medicaid program, the options are anything but palatable.
If the effort fails, the party risks being tarred as feckless: in control of the House, the Senate and the White House, but unable to come through with a promise that Republicans have been making from the day Mr. Obama signed the Affordable Care Act into law in 2010.
If the effort succeeds, expansion-state Republicans face the prospects of political hellfire: blame for every potential glitch in the health care system, from premium increases to canceled health plans and benefit losses.
âThe fact remains that Dean Heller owns his partyâs destructive health care repeal effort,â William McCurdy II, chairman of the Nevada State Democratic Party, said in a prepared statement. He added, âThe damage to Dean Hellerâs flailing re-election campaign was already done long before this desperate press conference.â Mr. Heller did not respond through his spokeswoman.
Mr. Heller, 57, represents the sort of state, both rural and working class, that has much to lose from the repeal of the Affordable Care Act. Nevada was once a national leader in the number of uninsured, but now the program has insured tens of thousands of its residents.
The state, like many around the country, has suffered a prescription drug crisis, and has among the highest rates of prescription painkillers sold and drug overdose deaths per capita. It also has a growing population of residents over the age of 55, a group particularly hammered by the Senate bill. All this has led Mr. Sandoval to take an unusually aggressive position for a Republican governor to preserve the current law.
Other Republican senators like Mr. Heller â notably Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska, Shelley Moore Capito of West Virginia and Rob Portman of Ohio â come from states with similar populations and problems and have expressed skepticism about aspects of the bill.
Further complicating the matter are the four conservative Republicans â Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin â who have already declared that they cannot support the health bill without changes to make it even more frugal. That put Senate leaders on notice that any move to placate the Dean Hellers of the Senate might only alienate other lawmakers still further.
Mr. McConnell continues to project confidence, even as the enthusiasm for the bill is largely muted. âIâm pleased that we were able to arrive at a draft that incorporates input from so many different members who represent so many different constituents who are facing so many different challenges,â Mr. McConnell said last week. He added: âThere will be ample time to analyze, discuss and provide thoughts before legislation comes to the floor. And I hope every senator takes that opportunity.â
In fact, on the day last week that the bill was rolled out, Mr. Heller posted on Twitter a photo of himself sitting in an ornate chair plowing through it, a considerable feat of reading given the arcana of the billâs statutory language. But in spite of his earnest decoding of phrases like the âapplicable median cost benchmark plan,â what Nevadans have to say will probably have more impact â especially Mr. Sandoval, the most popular public official in the state, to whom Mr. Heller owes much.
The governor appointed Mr. Heller to the Senate seat in 2011 after the resignation of fellow Republican John Ensign and supported him during his successful run for a full term in 2012.
âHere is one thing that people donât talk about a lot with Heller: He doesnât like the job,â said Jon Ralston, editor of the Nevada Independent, a nonprofit news organization. âHe was planning to run for governor.ââ
But Adam Paul Laxalt, the current Nevada attorney general, the grandson of former Senator Paul Laxalt of Nevada and the son of former Senator Pete Domenici of New Mexico â is widely expected to run and has more or less pushed Mr. Heller out of the way.
Mr. Heller has never been the sort of rainmaker for the state that Senator Harry Reid of Nevada, the Senate minority leader from 2015 until early this year, was. Nor has he been a legislative leader. âThe bottom line with Nevadans historically had been if you took care of the home issues, then how you voted in D.C. on the other stuff was less important,â said Michael Green, an associate professor of history at the University of Nevada, Las Vegas.
Mr. Heller appears to be running for re-election on a dogged effort to prevent the Trump administration from restarting licensing activities at the Yucca Mountain nuclear waste dump outside of Las Vegas. Beyond that, he has few other issues to lean on, and is stuck swatting away at critics from the left and the right as he struggles to define himself on health care, come what may.
âNow he in this position of his own making,â Mr. Ralston said, âpressed by Trump people on one side, so he has a base problem, while the other side is running the most relentless digital protest campaign on any piece of legislation I have ever seen in this state.â
The threat on Mr. Hellerâs right flank is real, as shown by former Representative Joe Heck, who during his race for a Senate seat in Nevada last year openly opposed Mr. Trump. Conservative voters stayed home and Mr. Heck lost to a Democrat.
Democrats have already recruited a Nevada freshman, Representative Jacky Rosen, to take Mr. Heller on. Representative Dina Titus is also looking at a possible run. âThis is probably going to be the last decision I make in my political career,â Ms. Titus said. âI want it to be the right one.â
In the meantime, Mr. Heller has a long week in Washington awaiting.