Healthcare wish lists: What moderates, conservatives want

Healthcare wish lists: What moderates, conservatives want
© Greg Nash

Divisions between moderate and conservative Senate Republicans on how to repeal ObamaCare appear to be widening.  

Senators from the two camps have vastly different ideas about what needs to be changed in the repeal-and-replace legislation, and it’s unclear what kind of compromise GOP leadership can present that would satisfy both sides.

Conservatives want the bill to end as many ObamaCare regulations and taxes as possible, while the moderates want more federal spending on Medicaid. Lacking a clear path forward, Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellDACA recipient claims Trump is holding ‘immigrant youth hostage’ amid quest for wall Former House Republican: Trump will lose the presidency if he backs away from border security Pence quotes MLK in pitch for Trump's immigration proposal MORE (R-Ky.) delayed a vote on the bill until after the July Fourth recess.

With a slim 52-48 majority in the upper chamber, GOP leaders can only afford to lose two votes and still pass healthcare legislation, assuming Vice President Pence breaks a tie. Senate leaders want to finish negotiations by the end of this week, but there’s skepticism that timeline can be met.

With that in mind, here’s what the two sides are asking for.



Conservatives in the Senate, led by Sen. Ted CruzRafael (Ted) Edward CruzGroup aiming to draft Beto O’Rourke unveils first 2020 video Howard Dean looking for a 'younger, newer' Democratic nominee in 2020 Congress can stop the war on science MORE (R-Texas), believe they’ve gained leverage in recent days, and their demands have grown louder.

They think the legislation as written doesn’t go far enough to repeal ObamaCare or lower premiums. They also say the bill authorizes too much federal spending on subsidies to help low-income people afford health insurance.  

The easiest way to bring conservatives on board would be to repeal all of ObamaCare’s insurance regulations. Sens. Mike LeeMichael (Mike) Shumway LeeHillicon Valley: Trump AG pick signals new scrutiny on tech giants | Wireless providers in new privacy storm | SEC brings charges in agency hack | Facebook to invest 0M in local news AG pick Barr wants closer scrutiny of Silicon Valley 'behemoths' Grassroots political participation is under attack in Utah and GOP is fighting back MORE (R-Utah), Ron JohnsonRonald (Ron) Harold JohnsonCongress sends bill renewing anti-terrorism program to Trump The Hill's Morning Report — Shutdown fallout — economic distress Hillicon Valley: Republicans demand answers from mobile carriers on data practices | Top carriers to stop selling location data | DOJ probing Huawei | T-Mobile execs stayed at Trump hotel as merger awaited approval MORE (R-Wis.) and Cruz think gutting those rules is the quickest way to bring down premiums.

“If we were to repeal all of the market reforms, utilize high-risk pools to make sure people with pre-existing conditions were covered, we could literally drive down the gross premiums for every American,” Johnson said.  

Sen. Rand PaulRandal (Rand) Howard PaulPressure mounts for Trump to reconsider Syria withdrawal House Republicans call for moving State of the Union to Senate chamber GOP rep: 'Rand Paul is giving the president bad advice' on Afghanistan and Syria MORE (R-Ky.) has also sided with the conservatives on repealing the regulations, but on Wednesday released his own wish list, separate from what Cruz, Lee and Johnson have been asking for.

Paul is also asking that McConnell drop a provision added earlier this week that would require individuals who miss an insurance payment to wait six months before being able to sign back up for insurance. He also called for leadership to remove a provision that appropriates a “stability fund” to shore up the ObamaCare exchanges.   

Repealing all the ObamaCare rules would include getting rid of the regulations that prevent insurers from discriminating against people with pre-existing conditions. The Senate bill would let states waive some of those protections, but many of ObamaCare’s insurance rules would remain.

If leaders accede to the conservative demands, they risk inviting the kind of public backlash that plagued the House GOP bill. They also risk losing the support of moderates like Sen. Bill Cassidy (R-La.).



The most vocal GOP moderate on this issue is Sen. Susan CollinsSusan Margaret CollinsTrump pitches new plan to reopen government amid Dem pushback The Memo: Concern over shutdown grows in Trump World Overnight Defense: Trump unveils new missile defense plan | Dems express alarm | Shutdown hits Day 27 | Trump cancels Pelosi foreign trip | Senators offer bill to prevent NATO withdrawal MORE (Maine). Collins has expressed concerns over the legislation early and often. After the vote was delayed, she said she wasn’t sure the measure could be changed to win her over.

Collins said she has “so many fundamental problems with the bill that have been confirmed by the [Congressional Budget Office] report that it’s difficult for me to see how any tinkering is going to satisfy my fundamental and deep concerns about the impact of the bill.”

Moderates are also fretting about the bill’s impact on Medicaid. The legislation would roll back ObamaCare’s Medicaid expansion and put a cap on federal funding to states for the first time.

GOP senators from expansion states such as Rob PortmanRobert (Rob) Jones PortmanSenators look for possible way to end shutdown GOP reasserts NATO support after report on Trump’s wavering Leaders nix recess with no shutdown deal in sight MORE (Ohio) and Shelley Moore CapitoShelley Wellons Moore CapitoOvernight Energy: Wheeler weathers climate criticism at confirmation hearing | Dems want Interior to stop drilling work during shutdown | 2018 was hottest year for oceans Dems blast EPA nominee at confirmation hearing Republican senators skeptical of using national emergency for wall funding MORE (W.Va.) have pushed for a seven-year phaseout of the Medicaid expansion, rather than the three years currently in the bill.

GOP leadership could also consider making the bill’s tax credits more generous. The Congressional Budget Office projected the legislation would disproportionately benefit younger, healthier people.

Capito said she wants “more robust help for older and less affluent rural people.”

But spending more on subsidies is exactly the opposite of what conservatives want.  

Capito and Portman are also pushing for $45 billion over 10 years to combat the opioid epidemic in their states. But even if McConnell bolstered the opioid funding, Capito suggested it probably wouldn’t be enough to secure her support.

“More opioid funding would be very good and very beneficial, but the core for me is the Medicaid provision,” Capito said.