PALCO, Kansas — Jerry Moran is usually a reliable conservative in the Senate, who still boasts that he was the first member of Congress to introduce a bill that repeals Obamacare.

But here in this rural northwestern Kansas town, Moran stresses that coverage for pre-existing conditions has to be protected. He rails against the decision by his own leadership to draft its Obamacare repeal measure almost entirely in private. The genial senator even steers away from derisively referring to the 2010 health care law as Obamacare, instead using its official term: The Affordable Care Act.


“I’m very interested in making sure pre-existing condition is covered and I wouldn’t consider it covered if it could be taken away in some other fashion,” Moran said Thursday in a health-care-dominated town hall. “Who in the room doesn’t have a pre-existing condition? Don’t we all?”

The outpouring of concerns raised not just by voters, but Moran himself, before this community of 300 people underscores how worry about Obamacare repeal has rippled deep into conservative territory — threatening to upend an already fragile push by the GOP to achieve a core legislative promise.

In a surprise move last week, the second-term GOP senator came out in opposition against the initial version of the Senate Republican health care proposal. Few had seen a potential naysayer in Moran, a former chairman of the National Republican Senatorial Committee, who is rarely a squeaky wheel. And his vote is crucial.

“Hopefully, leadership will be responsive to his concerns,” South Dakota Sen. John Thune, the third-ranking Senate Republican, said in an interview last week in Washington. “He’s somebody that — ultimately, in the end — we have to have in order to pass this.”

But Moran is facing rising pressure here at home, similar to the onslaught raining down on other swing-vote senators from more moderate regions or states that took advantage of the Medicaid expansion under Obamacare. Even though Kansas, where 57 percent of the state voted for Donald Trump, is neither.

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Meanwhile in Kansas, his party is in the middle of a series of internecine Republican battles that has pit the GOP-led Legislature against conservative Gov. Sam Brownback, with a recent tax fight in Topeka ending after legislators overrode a Brownback veto and raised taxes after years of tax and spending cuts. The move demonstrated the limits of how far right some Republicans are willing to go to scale back public benefits, even in a conservative state.

For Moran, in one ear are groups like the Kansas Hospital Association, which notes that the Senate repeal bill would not only bar the state from expanding Medicaid eligibility but asks states like Kansas that didn’t expand to shoulder the costs for states that did — a concern echoed by Moran on Thursday. The GOP-controlled Legislature voted to expand Medicaid earlier this year, only to meet a veto from Brownback that lawmakers could not override.

Thomas Bell, the hospital group’s president and CEO, called the Senate GOP bill a “double whammy” to the state.

“I think that was something he paid attention to,” Bell said of Moran. “But I really think that the bottom line for him, he was very concerned about what he heard from people who were talking about what this would do to our Medicaid program.”

The Urban Institute says about 120,000 residents in Kansas would lose coverage under the Senate Republican plan, which disproportionately hits the state’s older and more rural population, according to David Jordan, executive director of the Alliance for a Healthy Kansas.

Yet Moran is also hearing from party stalwarts who want the GOP to follow through on their years-long pledge to uproot the health care law. All four House Republicans from Kansas voted in favor of their Obamacare repeal measure in May, and undoing the law remains largely popular throughout the state.

“They’ve been campaigning against Obamacare and rightfully so, for six or seven years,” Rooks County GOP Chairman Jim Circle said. “It’s time to do it and get on to other items on Trump’s agenda.”

But those voices were rare even in this rural, conservative town, located 15 miles west of Moran’s boyhood home of Plainville and in a county where 84 percent of voters cast a ballot for Trump last November.

One attendee after another at the town hall, which was saturated by health care questions, raised concerns about dismantling Obamacare and praised Moran for opposing the Senate GOP bill. Even after the town hall ended, Moran listened to worries from disabled constituents about cuts to Medicaid.

After one questioner noted that Moran earlier in the week said Kansans were not better off under Obamacare, the senator responded: “There are people who tell me they are better off and I believe them.”

During the roughly 90-minute event, Cheryl Hofstetter Duffy, 58, of neighboring Hill City, pressed the senator on why lawmakers won’t work together to improve Obamacare, rather than unravel it.

“I would not support him” if Moran voted to repeal Obamacare, said Duffy, who said she is a registered Democrat but has previously voted for Moran. “Oh, it is that critical. Absolutely. I voted for him in the past because I really felt he was putting people ahead of party.”

Moran’s opposition to the initial version of the Republican health care plan had been somewhat of a mystery on Capitol Hill, and he still isn’t considered among the top tier of headaches for GOP leaders.

But here in Palco, Moran was not shy about rattling off his critique of the Senate GOP bill.

He also veered off the party message saying he would have preferred a process to “figure out where there are 60 votes to pass something that is so important to many Americans,” implicitly rejecting the partisan fast-track approach GOP leaders deployed. It’s “almost impossible to try to solve” the Republicans’ health care dilemma with just 50 votes, Moran added.

There are limits to how specific Moran would be, however.

He declined to take a position on a Trump proposal espoused by conservative senators that would repeal Obamacare now and come up with a replacement later. And he didn’t rule out an idea from conservative GOP Sens. Ted Cruz of Texas and Mike Lee of Utah that would allow insurers to sell health insurance that didn’t comply with current Obamacare regulations, as long as the companies offered other plans that covered pre-existing conditions.

“I don’t know what the consequences are of that plan,” Moran said of a proposal that moderates are resisting.

Still, it’s unclear at the end of the day exactly how problematic Moran will be for Senate Majority Leader Mitch McConnell as he tries to round up votes in favor of the party’s plan. Senior Republicans have tried to downplay Moran’s rejection of the initial GOP bill.

“Since people know that that was a discussion draft and that wasn’t the final draft, then obviously I don’t think there’s any big reason to come out with guns blazing in support of the bill,” Senate Majority Whip John Cornyn of Texas said last week of Moran’s opposition.

Moran’s moment in the spotlight Thursday — a horde of national and state media descended on the tiny town — is unusual for the low-key Kansan who helped secure the GOP Senate majority as NRSC chairman during the 2014 election cycle.

Even then, Moran didn’t use his successful chairmanship to climb the leadership ladder, unlike previous heads of the Senate GOP’s campaign arm. Instead, Moran notched a plum spot on the Senate Commerce Committee — especially valuable for his state’s aviation industry.

During his first bid for the Senate in 2010, he and primary opponent Todd Tiahrt spent much of their contentious campaign running to the right of each other. When he was sworn in to the Senate in 2011, Moran quickly joined the Tea Party Caucus with the likes of former Sen. Jim DeMint (R-S.C.), an intellectual godfather to conservatives.

At the same time, Moran has faced the right’s wrath before.

During a round of town halls last year, Moran argued in favor of holding a hearing for Merrick Garland, President Barack Obama’s final Supreme Court nominee. Those remarks riled conservatives, and one group threatened to run ads against Moran to get him back on the party line in the high court standoff.

Then-Rep. Mike Pompeo (R-Kan.) issued unusually harsh remarks against Moran during the Garland fracas and subsequently entertained a primary challenge, although he ultimately declined a run. When Pompeo, now CIA director, had his confirmation hearing earlier this year, he was introduced by the other Kansas senator, Republican Pat Roberts, and former Sen. Bob Dole, but not Moran.

Aside from the Garland-fueled uproar last spring, Kansas Republicans say Moran has largely stayed above the GOP civil war in the state.

“I think people know where he is on most of those big issues, whether it’s taxes or social issues,” said Jeff Glendening, the Kansas director for Americans for Prosperity and a longtime political operative in the state. “And I think that helps.”

But Rep. Roger Marshall (R-Kan.), who won Moran’s old House seat by ousting the conservative troublemaker Tim Huelskamp in a nasty primary last year, noted that Moran has had to adjust his perspective over the years.

“I think as he’s went from representing the Big First district, which is very conservative,” Marshall said, “he’s had to broaden his spectrum and look at the whole state.”