DES MOINES, Iowa — Joni Ernst promised to “unload” on Obamacare in a 2014 campaign ad that featured her firing a gun as a narrator described what she would do to the Democratic health care law.

But three years after winning election to the Senate on a vow to seek an “immediate" repeal of the law, the Iowa senator is being very careful about pulling that trigger.


“I am legitimately undecided on this,” she said here Friday after relentless attempts by questioners in the state’s two largest cities to pin her down on the health care bill under consideration in the House in the state’s two largest cities. “And you will hear that from a number of my colleagues, as well.”

Ernst was part of a Republican wave election that year that brought 12 new GOP members to the Senate and secured a Republican majority. Without exception, the winners used the unpopular law and its bungled launch to propel them to victory.

But as Obamacare’s popularity has improved, those same senators are now among the most prominent critics of the Republican proposal to undo the law being pushed by Speaker Paul Ryan and President Donald Trump. A Congressional Budget Office estimate this week that the plan would leave 24 million more people uninsured and increase premiums in the short term has only heightened the anxiety.

Indeed, now Ernst is using the word “deliberative” when describing her state of mind about replacing Obamacare. She emphasizes that pre-existing conditions must be covered and that children up to the age of 26 be able to remain on their parents’ insurance plan, both of which the Republican alternative would require.

Ernst insists she still wants to dismantle the law, but admits it’s not quite as simple as the “repeal and replace” mantra seemed in 2014.

“We have to take this up and move cautiously,” she said after an event in Cedar Rapids, a Democratic bastion. “When digging into it, it is much more complicated than simply saying ‘repeal Obamacare.’”

Health care is clearly top of mind in Iowa, where about 150,000 Iowans have benefitted from the Medicaid expansion under Obamacare and nearly 50,000 more have used subsidies to buy healthcare on the Obamcare exchanges. While the longtime swing state has veered more firmly into the Republican column the past two election cycles, how Ernst handles the Obamacare debate could determine just how tough a reelection challenge she receives in 2020.

“You’re talking about people getting kicked off health care. If Medicaid is rolled back and Ernst votes for it, they’re going to have a reason to be mad,” said Brad Anderson, Barack Obama’s Iowa director in 2012.

What’s remarkable is that Ernst’s ambivalence about the current repeal plan is echoed by a majority of the Senate Republican class of 2014, by and large a very conservative bunch. They’re now threatening to make Majority Leader Mitch McConnell’s life far more difficult if and when the House sends over its plan to roll back Obamacare’s Medicaid expansion and replace its subsidies with skimpier tax credits.

Sens. Cory Gardner of Colorado and Shelley Moore Capito of West Virginia are balking at plans to reverse the Medicaid expansion. Sens. Bill Cassidy of Louisiana and Steve Daines of Montana are worried about the CBO projections of fewer people covered and only marginally lower premiums over time.

Those senators all supported a complete repeal of Obamacare in the past.

Sen. Tom Cotton (R-Ark.), a magnet for attention, has been taking the fight to Speaker Paul Ryan’s plan, warning that House Republicans could get steamrolled in the next election if they vote for it. During his 2014 campaign, the Republican vowed to “start over” on Obamacare — not far off from the advice he’s now offering his House counterparts.

“There’s not a reason to rush. We should get it right,” Cotton said in an interview this week. “I am speaking out for the people I serve in Arkansas. And I just don’t think this bill is going to work for them.”

Such blunt assessments are not Ernst’s style. But people who know her say she’s similarly apprehensive about where Republicans are going on health care.

“The way she’s approaching the future of Obamacare is consistent with the job she’s been doing as a senator since she's been elected. Thoughtful, deliberate and going her own way,” said Matt Strawn, a former Iowa GOP chairman. “Most of the Republicans I talk to don’t want to be in the business of taking away peoples’ coverage.”

Ernst bobbed and weaved as she was berated over almost any negative comment she made about the health care law at a pair of rollicking town hall meetings on Friday. Constituents shouted at the former lieutentant colonel in the Iowa National Guard to “answer the question!” — particularly about potential cuts to Medicaid — but Ernst she gave away little about which way she’s leaning on perhaps the most consequential decision of her political career.

Sen. Tom Cotton, a magnet for attention, has been taking the fight to Speaker Paul Ryan’s health care plan.

Ernst she said that she wants an opportunity to amend the House proposal before committing to anything.

“I will continue to evaluate this,” she said in Cedar Rapids. “I want to make sure it works for Iowans."

Some Democratic constituents at the events were nonetheless convinced that she’ll fall in line with Republicans, and just didn’t want to deliver the bad news to liberal crowds.

“I would assume so,” said Perry Howell of Iowa City, who was holding a sign that read, “Sen. Ernst please don’t castrate Obamacare” — a reference to a viral ad she ran in 2014 vowing to make Washington squeal like a pig. “She had very politic answers. She knows that she’s in a hostile environment.”

“She wants to appear cautious. But I don’t think she is. How does she not really see what a disaster [the House bill] is?” fumed Peter Fisher of Solon, who works for a left-leaning think tank.

Ernst’s colleagues disagree. They say she’s been privately raising concerns centered around the Medicaid expansion — but it’s just not like her to throw bombs or invite public party infighting. The first female combat veteran to serve in the Senate, Ernst has cut a low-key, heads-down profile in the Senate as she works to build seniority and a power base in the cliquey chamber.

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“She’s very concerned about the Medicaid states. Hers is one of them. The present solution in the House is not something that is easily supportable,” said Sen. John McCain (R-Ariz.), who campaigned tirelessly for Ernst.

Ernst wouldn’t go that far in her public remarks at the two town halls followed by lengthy sessions with reporters. Perhaps it’s because she was prepared for incoming fire from the swath of Democratic voters who pressed her not just on Obamacare, but also climate change, Planned Parenthood and gun control.

Though Ernst generally handled the combative crowds calmly, not taking apparent offense at the jeers and signs that caricatured her as “Miss Piggy.” But she did bristle at one point when someone asked how she could be considering a plan that would cut benefits while she enjoyed generous government insurance.

“I don’t take the Senate insurance. I am on TriCare,” Ernst responded. “I don’t have the fancy Senate plan.”

Though Ernst was in unfriendly if not hostile territory, tours of the state’s more liberal urban areas are a near-requirement as she follows in the footsteps of Sen. Chuck Grassley (R-Iowa), who’s famous for his 99-county tours.

And despite ample evidence that some the questioners coordinated ahead of time — using similar phrases and distributing signs among themselves to egg Ernst on — the senator said the concerns she heard on Friday were all “valid.”

“There’s a level of angst out there and most of it centers on health care,” Ernst said after the event at Drake University in Des Moines. “It’s a very personal issue. It’s an emotional issue … I understand that."