Most Conservative U.S. Senators of 2025

The top-ranked U.S. Senators by 2025 Reform Healthcare scorecard score, based on substantive votes tracked by Center for Healthcare Affordability.

See the methodology page for how scores are calculated.

Rank	Lawmaker	Party / State / District	2025 Score
1	Sen. Rand Paul	R-KY	100%
2	Sen. Alan Armstrong	R-OK	100%
3	Sen. Todd Young	R-IN	93%
4	Sen. Tim Scott	R-SC	93%
5	Sen. John Cornyn	R-TX	93%
6	Sen. James Lankford	R-OK	93%
7	Sen. Ashley Moody	R-FL	93%
8	Sen. John Barrasso	R-WY	93%
9	Sen. Jim Banks	R-IN	93%
10	Sen. Steve Daines	R-MT	93%
11	Sen. Jim Risch	R-ID	92%
12	Sen. Marsha Blackburn	R-TN	92%
13	Sen. John Thune	R-SD	92%
14	Sen. Michael Crapo	R-ID	92%
15	Sen. Roger Wicker	R-MS	92%
16	Sen. Eric Schmitt	R-MO	92%
17	Sen. Tommy Tuberville	R-AL	92%
18	Sen. Jon Husted	R-OH	92%
19	Sen. Cynthia Lummis	R-WY	92%
20	Sen. Bernie Moreno	R-OH	92%
21	Sen. Mike Rounds	R-SD	92%
22	Sen. Ted Budd	R-NC	92%
23	Sen. Ted Cruz	R-TX	92%
24	Sen. John Curtis	R-UT	92%
25	Sen. Deb Fischer	R-NE	92%
26	Sen. John Kennedy	R-LA	92%
27	Sen. John Hoeven	R-ND	92%
28	Sen. Lindsey Graham	R-SC	92%
29	Sen. Bill Hagerty	R-TN	92%
30	Sen. Katie Britt	R-AL	92%
31	Sen. Dave McCormick	R-PA	92%
32	Sen. Mitch McConnell	R-KY	92%
33	Sen. Peter Ricketts	R-NE	92%
34	Sen. Tom Cotton	R-AR	92%
35	Sen. Jerry Moran	R-KS	92%
36	Sen. Roger Marshall	R-KS	91%
37	Sen. Mike Lee	R-UT	91%
38	Sen. Ron Johnson	R-WI	91%
39	Sen. Shelley Capito	R-WV	90%
40	Sen. Joni Ernst	R-IA	89%
41	Sen. John Boozman	R-AR	89%
42	Sen. Rick Scott	R-FL	89%
43	Sen. Tim Sheehy	R-MT	89%
44	Sen. Markwayne Mullin	R-OK	89%
45	Sen. Jim Justice	R-WV	89%
46	Sen. Cindy Hyde-Smith	R-MS	89%
47	Sen. Kevin Cramer	R-ND	88%
48	Sen. Bill Cassidy	R-LA	87%
49	Sen. Thom Tillis	R-NC	84%
50	Sen. Charles Grassley	R-IA	82%