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AUSTIN — During a week most Republican senators spent in the political equivalent of the witness protection program, Sen. Ted Cruz willingly stood trial before his constituents all across this sprawling state over his push to repeal much of the Affordable Care Act.

He debated a self-described “dirty liberal progressive.” He met a psychologist who told him that he and his colleagues were “scaring the living daylights” out of her. He encountered protesters in a border town, a conservative Dallas suburb and this liberal stronghold.

Some who attended his events took the opposite view — that not shredding the law known as Obamacare would be the real misdeed. But Cruz’s main offense, in the view of the most vocal and most frustrated attendees, has been to participate in GOP efforts to undo key parts of, and possibly repeal, the Affordable Care Act.

Ilana Panich-Linsman

for The Washington Post

Bill Kelberlau, 68, of Georgetown, Tex., speaks with a reporter after the Cruz town hall in Austin.

Cruz is grappling with a state that, much like the rest of the country, has been deeply divided and firmly gripped by the months-long GOP effort to fulfill its signature campaign promise. Virtually everywhere he traveled this week, no matter where the conversation started, it inevitably veered to health care. That may help explain why so many of his colleagues kept a low profile over the week-long Fourth of July recess.

But Cruz, who built a national reputation on strident conservatism and has fiercely criticized the ACA for years, seemed to relish debating health care with vocal liberal critics. In a red state where he holds little crossover appeal, Cruz sees his best path to a second term, which he will seek next year, in rallying his conservative base to turn out for him. Even as he alienates a growing number of voters concerned about the fate of the ACA, doing his part to push for a full or even partial repeal is one key way his allies believe he can make that happen.

Whether such legislation can pass, as Congress returns to work Monday for one more push on the issue before the August recess, is increasingly uncertain — to both Cruz and Senate GOP leadership. “I believe we can get to yes,” said Cruz this week. “I don’t know if we will.”

A willingness to engage with opponents

Cruz spent Thursday evening in a hotel ballroom here at a town hall hosted by Concerned Veterans for America, a group backed by the billionaire conservative Koch brothers. The organization held two events for Cruz over the past week, with one more coming Saturday, with the aim of offering a more controlled environment than typical town hall meetings.

Ilana Panich-Linsman

for The Washington Post

Cruz takes some heated questions from audience members in Austin.

To attend, people were required to register in advance. The group’s policy director, Dan Caldwell, moderated the discussions, keeping them mostly focused on veterans’ issues and selecting a handful of audience questions submitted in advance.

The first half of Thursday’s event here so closely resembled Wednesday night’s version in suburban Dallas that Cruz even cracked the same joke about banishing bureaucrats to Iceland — and received similarly limited laughter.

But the predictability ended when Gary Marsh and others jumped in without being called on by Caldwell and engaged Cruz in a tense back and forth over health care.

“Can I please request that you refer to it as the Affordable Care Act,” Marsh told Cruz at one point. Cruz declined, drawing some applause. The senator said he did not believe in “deceptive speech” — prompting outraged laughter from his critics.

Cruz, dressed in a dark blazer, khaki pants and brown cowboy boots, then launched into a detailed defense of his opposition to Obamacare and the imperative to roll it back.

Caldwell tried to redirect the conversation to the questioner he had originally called on. But Cruz overruled him, allowing Marsh a chance to respond. Marsh, a 67-year-old retiree, said he knew he could not change Cruz’s mind, but he hoped to sway others in the room.

“Repealing Obamacare was the single biggest factor producing a Republican House, a Republican Senate and I think ultimately a Republican president,” Cruz said. He said the “central focus” of Republicans now should be to lower premiums.

Ilana Panich-Linsman

for The Washington Post

A police officer stops protesters from protesting on hotel property at the Renaissance Austin Hotel, where Cruz held his town hall.

Marsh proudly called himself a “dirty liberal progressive” in a conversation with reporters after the event. John Walker, 69, walked over to confront him. The self-described conservative wasn’t pleased.

“You monopolized the meeting. That’s the problem I have with you and everybody else that does that,” Walker told him. In an interview, Walker, who is retired and on Medicare, said he favors replacing Obamacare with “something better” that would make coverage affordable for his adult children, who can’t afford premiums. He said he is not yet convinced the Senate GOP bill would accomplish that.

A similar flash of discord appeared Wednesday in McKinney, the Dallas suburb. After Cruz finished speaking, Buddy Luce was not happy with what he heard from the Texas Republican senator about overhauling Obamacare.

“I’m not impressed with a plan that takes away —” the 65-year-old attorney started explaining to a reporter. Before he could finish his thought, Ivette Lozano had rushed over to argue with him.

“I’m a family practitioner,” she told him. “Obamacare is putting me out of business.”

“Don’t you think health care is a human right?” he asked her.

“No, I think it’s personal responsibility to take care of you,” she responded.

“If you don’t think health care is a human right, then we’re just on a different wavelength,” Luce retorted.

Obamacare is a ‘manifest disaster’

For 47 minutes, the McKinney town hall was free of controversy. As Cruz spoke to Caldwell about veterans’ matters, the audience listened quietly. But then came a query from a far corner of the hotel ballroom. And the mood quickly shifted.

“You all on the Hill are scaring the living daylights out of us with the health-care nonsense that you’re doing,” said Misty Hook, who described herself as an “overflow” psychologist who works with veterans unable to obtain services through the Department of Veterans Affairs. She worried about the GOP push to allow insurers in some states to opt out of certain coverage requirements.

“What are you going to do to help make sure that mental-health-care services are reimbursed at a proper rate so that we can continue to provide services for veterans?” asked Hook, the urgency apparent in her voice.

Cruz, leaning forward in his armchair, offered an extended defense of the effort to undo key parts of Obamacare. He called it a “manifest disaster,” prompting some to shake their heads in disagreement.

“You didn’t answer her question about how mental health is going to be covered,” one woman interjected.

“Well, I am answering it right now,” Cruz replied. But before he could continue, Luce abruptly jumped into the conversation from the other side of the room. He continued breaking in, eventually drawing a warning from the senator: “Sir, I’m happy to answer your questions, but I’m not going to engage in a yelling back-and-forth.”

Outside the event, a few dozen protesters held up signs emblazoned with such messages as “GOP Care Treats the Rich Kills the Weak” and “Yea! ACA fix it don’t nix it.” Cruz had encountered similar protests when he visited McAllen on the U.S.-Mexico border earlier in the week.

After the event, Cruz called the health-care back-and-forth a “good and productive exchange.”

“This is an issue that inspires passion and quite understandably. People care about their health care,” said Cruz.

A push for a more aggressive rollback of the ACA

Many close observers believe Cruz is likely to vote yes on the final version of the bill, even though he does not support the initial version Senate Majority Leader Mitch McConnell (R-Ky.) released last month. Although many other Republican senators believe the first draft would go too far and push too many Americans off insurance rolls, Cruz is pressing for a more aggressive undoing of the ACA’s regulations.

The Texan’s top priority is his amendment to let insurers sell plans that don’t comply with ACA coverage requirements so long as they also offer plans that do. He is casting the amendment as a move to give consumers more, less expensive choices in purchasing insurance.

But critics including Sen. Bill Cassidy (R-La.) worry that such an approach would “dissolve the risk pool” established by the ACA that brings together healthy and sick individuals — and could result in higher costs for less healthy Americans.

The Cruz amendment has become a rallying cry among those on the right pushing for a more aggressive bill, with figures such as House Freedom Caucus Chairman Mark Meadows (R-N.C.) and a constellation of conservative activist groups endorsing it. It has also drawn support from White House legislative affairs director Marc Short.

McConnell’s plans to vote on the bill before July 4 fell apart amid GOP discord. Now as he works to change the bill — and as a handful of key senators have faced a drumbeat of opposition to the proposal during the recess — it remains as uncertain as ever whether he will ever have enough Republican support to pass.

[At parades and protests, GOP lawmakers get earful about health care]

[A town hall in Kansas shows Republican struggles with health-care bill]

Ilana Panich-Linsman

for The Washington Post

Bob Kafka, 71, a disabled Vietnam veteran, talks with an Austin police officer as he and others try to enter the Renaissance Austin Hotel property, where Cruz held a town hall meeting Thursday. “Ted Cruz is hosting veterans today, but he doesn’t represent all veterans,” Kafka said.

Cruz, like President Trump, thinks that if they fall short, the Senate ought to vote on a narrower bill to repeal the law — what he calls a “clean repeal” — and focus on replacing it afterward. But McConnell has embraced a very different kind of backup plan: Working with Democrats on a more modest bill to stabilize insurance markets.

Broad disagreements over how to structure the nation’s health-care system are sharpening the contrasting way lawmakers such Cruz are viewed at home.

As she stood in line with her husband to talk to Cruz after the Wednesday town hall, Jennifer Beauford, 42, said she wants a “full repeal and I don’t want a replacement.”

“Health care is not constitutional right. It’s a privilege,” said Beauford, who identified as a conservative Cruz supporter.

Outside among the protesters stood Kerry Green, 46, a history teacher who wore a shirt printed with the Declaration of Independence. A self-identified Democrat, Green held up sign urging health care “for the 21st Century” rather than the 20th. She sharply criticized the GOP bill.

As for Cruz? “He needs to go,” she said.

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