Too many cooks threaten GOP healthcare bill

Too many cooks threaten GOP healthcare bill
© Greg Nash

Senate Republicans may have too many cooks in the kitchen when it comes to healthcare, and it’s complicating efforts to draft an ObamaCare replacement bill.

The main Senate group working on crafting healthcare legislation is the task force of 13 men backed by Senate leaders. It won negative attention early on for its lack of women, at which point GOP leaders opened it up to all members.

There’s also a rival group led by Sens. Bill Cassidy (R-La.) and Susan CollinsSusan Margaret CollinsWhite House weighs clawing back State, foreign aid funding The Hill's Morning Report: Dems have a majority in the Senate (this week) Overnight Defense: Pompeo creates 'action group' for Iran policy | Trump escalates intel feud | Report pegs military parade cost at M MORE (R-Maine), who have been outspoken opponents of the House-passed American Health Care Act and co-sponsored their own version of an ObamaCare replacement bill called the Patient Freedom Act.

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Yet another group is led by Sen. Rob PortmanRobert (Rob) Jones PortmanSenate panel spars with Trump administration over treatment of unaccompanied immigrant children Senate study: Trump hasn’t provided adequate support to detained migrant children Senators introduce bill to change process to levy national security tariffs MORE (R-Ohio) and is focused on Medicaid expansion.

And then there’s the faction of conservatives that includes Sens. Ted CruzRafael (Ted) Edward CruzCruz calls out O'Rourke for supporting NFL players' protests during anthem Beto O’Rourke: Term limits can help keep politicians from turning into a--holes Election Countdown: GOP worries House majority endangered by top of ticket | Dems make history in Tuesday's primaries | Parties fight for Puerto Rican vote in Florida | GOP lawmakers plan 'Freedom Tour' MORE (R-Texas) and Mike LeeMichael (Mike) Shumway Lee2020 hopefuls skeptical of criminal justice deal with Trump Sentencing reform deal heats up, pitting Trump against reliable allies Senate gets to work in August — but many don’t show up MORE (R-Utah). They’re not a formal working group, but they want the Senate bill to be as close as possible to the House bill.

That’s to say nothing of members from the House trying to weigh in on the process, GOP governors, who some senators say should have a larger role, and the Trump administration.

Republican senators appear to be aware of the potential problems.

“The only way of doing this, you can’t have 52 people drafting the bill,” Sen. Ron JohnsonRonald (Ron) Harold JohnsonDems to challenge Kavanaugh for White House records To solve the southern border crisis, look past the border GOP senator on revoking security clearances: 'I don't want to see this become routine' MORE (R-Wis.) recently told The Hill about the challenges faced by his conference.

The competing interests come amid increasing pessimism from GOP senators that they’ll arrive at a deal.

Republicans have little room for error. They can lose only two votes and get a bill out of the Senate, assuming united Democratic opposition.

Prior to this week, most senators were saying publicly they expected a vote by the August recess. But even that date is now being questioned. Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellTrump stays out of Arizona's ugly and costly GOP fight Sen. Warner to introduce amendment limiting Trump’s ability to revoke security clearances The Hill's 12:30 Report MORE (R-Ky.) has sounded skeptical that he can get the necessary 50 votes to pass a bill.

Senators haven’t been able to overcome the major differences that have plagued the repeal effort from the start. There’s no consensus on how to roll back Medicaid expansion, Medicaid spending levels or ObamaCare insurance regulations.

Senate leadership staff spent the recess writing draft language for senators to look at this week, using input from the meetings of the primary working group.

But according to a source familiar with the process, it’s not being presented as legislative language. Instead, it’s merely a collection of different ideas, proposals and decisions that still need to be made.  

Republican leaders are grappling with how to unite a party divided on multiple fronts, and the working group dynamic has made negotiations difficult.

“There are so many [working groups], and they’re focused on too many different components. It’s an anomaly,” one former Senate Republican aide said. “It makes it harder to get to a final product. When you have all these groups and members out there, it’s hard to get to a consensus.”

According to some former Senate staffers, part of the problem is that leadership decided early on to conduct its work outside of the normal committee process because it wasn’t going to be bipartisan.

“You have warring ideas within a committee, too. What’s unusual is for policy matters to completely bypass the key committees,” said John McDonough, a former senior adviser to the Democratic-led Senate Health, Education, Labor and Pensions Committee during the passage of ObamaCare.

“Usually, committees are very covetous of their influence and rebel against any effort to erode that authority,” and that isn’t happening here, McDonough said.

Without formal committee hearings or listening sessions, senators who would normally be involved in the decisionmaking process are suddenly finding themselves on the outside. So to make sure they have a voice, they’ve formed working groups.

On the flip side, senators such as Cruz and Lee who aren’t on the Health committee now have seats at the table.

“You wouldn’t have the same incentive to create these spin-off groups and special coalitions and working groups if you went through committees,” said Bill Hoagland, a vice president at the Bipartisan Policy Center and former director of budget and appropriations for the Republican Senate majority leader from 2003 to 2007.

Having a fragmented Republican caucus “definitely adds to the difficulty of getting to a consensus and agreement,” Hoagland said.

If progress is made, it’ll likely be done through the original McConnell-backed group.

“If the group of 13 comes up with something, all the other groups will fall away,” Rodney Whitlock, former acting health policy director for Sen. Chuck GrassleyCharles (Chuck) Ernest GrassleyDems to challenge Kavanaugh for White House records 2020 hopefuls skeptical of criminal justice deal with Trump Five things to know about Bruce Ohr, the DOJ official under fire from Trump MORE (R-Iowa), said.