Mr. Moran faced probing questions about health care, exposing constituents’ deep concerns about the Senate bill, though the gathering was notably polite. Dressed crisply in a suit, white shirt and red tie, Mr. Moran stood at the front of the packed room with the crowd spilling through an open doorway in the back.
A few feet from the senator, a woman in a pink Planned Parenthood T-shirt held a poster that offered a reminder of the recrimination Mr. Moran and his colleagues risk facing: “When you lose your health care remember who took it away,” it said, showing caricatures of the Senate majority leader, Mitch McConnell, the Kentucky Republican pushing the bill; President Trump; and Speaker Paul D. Ryan.
Mr. Moran represents a state Mr. Trump won by about 20 percentage points. He won his own re-election by an almost two-to-one ratio. He does not have to contend with pressure from a governor who has been publicly critical of the repeal bill, unlike colleagues from Nevada and Ohio. And yet he has become an unlikely holdout as Mr. McConnell tries to find the votes to pass a bill, starting next week.
The reservations expressed by a reliable conservative like Mr. Moran underline how daunting it will be for Mr. McConnell to work out a bill that 50 Republican senators can support.
In Palco — about halfway between Kansas City and Denver, and a short drive from where Mr. Moran grew up — the senator outlined how he was assessing the repeal legislation. Would it help or harm the availability of health care in communities across Kansas? Would it make premiums more affordable while still protecting people with pre-existing conditions?
The debate over repealing the health law is playing out in a year when Kansas has been buffeted by political turmoil and blunt challenges to conservative policy making. After years of budget woes, state lawmakers voted to reverse course from the sweeping tax cuts championed by Gov. Sam Brownback, a Republican.
They also voted to expand Medicaid under the Affordable Care Act, driven in part by concerns about the financial viability of rural hospitals. Thirty-one states have expanded Medicaid under the health law. But Mr. Brownback vetoed the measure, and lawmakers failed to override his veto.
“What we learned from Kansas is that policy matters,” said David Jordan, the executive director of the Alliance for a Healthy Kansas, which pushed to expand Medicaid. “When policy becomes too ideologically driven and strays away from what’s good for the people you serve, people are going to start to see that.”
Now, Mr. Jordan said, people are coming to the same conclusion about the Senate bill. “People realize that this is going to mean that their hospital may close, that they may have to pay more for coverage,” he said.
And the more that voters personalize the debate, the more fraught the politics become, reflecting the vast reach of the legislation. Elements of the bill that please some lawmakers, such as cutting Medicaid spending, are cause for opposition by others.
After Mr. McConnell scrapped plans for a vote last week, Mr. Moran announced that he opposed the measure, saying it “missed the mark for Kansans.”
Mr. Moran, who was chairman of the Republican campaign committee when the party won control of the Senate in 2014, is considered a durable party loyalist.
“If you lose Jerry Moran, you’ve lost part of the mainstream of the party,” said Burdett Loomis, a political-science professor at the University of Kansas. “If guys like him start unraveling, not just on health care but on other issues, McConnell has no chance of controlling that caucus.”
But Mr. Moran, in standing against the bill, risks alienating conservatives — though a primary challenge in 2022 is hard to imagine.
“I think for Senator Moran and others like him, it’s not enough to say, ‘Well, I don’t like the current bill,’” said former Representative Tim Huelskamp, a Republican who succeeded Mr. Moran in representing Kansas’ sprawling First Congressional District. “Tell me how you’re going to get to the point where the bulk of Obamacare is repealed, and when will you get it done?”
“We’ve waited six months plus seven years,” he added, “and now it’s time to get some action done in the U.S. Senate.”
Kansas’ other Republican senator, Pat Roberts, offered a strikingly different assessment of the Senate bill: Kansas, he said, “fared well under this draft.” Before the recess, according to The Associated Press, he offered an evocative description of how Republican senators were trying to come to agreement.
“Once in Glacier National Park, I saw two porcupines making love,” Mr. Roberts said. “I’m assuming they produced smaller porcupines. They produced something. It has to be done carefully. That’s what we’re doing now.”
Mr. Moran and Mr. Roberts have faced cross pressures — not just from voters in Kansas eager for the health law to remain in place, but also from medical professionals and state legislators.
Dozens of members of the Kansas Legislature, including numerous Republicans, signed a letter to Mr. Moran and Mr. Roberts saying that the repeal bill that passed the House in May would have “a profound negative impact on Kansas.” Hospitals, family physicians and other health care providers also urged the senators to oppose the bill.
But it remains to be seen whether Mr. Moran will stick with his opposition.
“I want to see if he’s actually going to have the nerve to do what he should do, or if he’s just going to be a puppy dog and follow along with what the Republicans ask him to do,” said Armin Kelly, a retired veterinarian at the meeting. “I think I know how he feels. It’s just whether he has the fortitude to stand up and do what he needs to do.”
Margy Stewart, a retired English professor, drove about three hours on Thursday morning to attend the meeting, and spoke approvingly of Mr. Moran’s stance against the bill.
“Senator Moran is clearly showing that he is not a rigid ideologue,” she said.
But she admitted that she was worried that might not last.
“That’s one reason I thought it was important to be here,” she said.
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