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 McConnellHouse to resume mask mandate after new CDC guidance Five takeaways from a bracing day of Jan. 6 testimony McCarthy, McConnell say they didn't watch Jan. 6 hearing 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 CruzTrump's Texas endorsement boosts a scandal-plagued incumbent while imperiling a political dynasty Trio of Senate Republicans urges Supreme Court to overrule Roe v. Wade Overnight Defense: US launches another airstrike in Somalia | Amendment to expand Pentagon recusal period added to NDAA | No. 2 State Dept. official to lead nuclear talks with Russia 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 LeeSenate confirms Biden's Air Force secretary Trio of Senate Republicans urges Supreme Court to overrule Roe v. Wade Biden signals tough stance on tech with antitrust picks MORE (R-Utah), Ron JohnsonRonald (Ron) Harold JohnsonGrassley pressured to run as Democrats set sights on Iowa Sunday shows preview: Bipartisan infrastructure talks drag on; Democrats plow ahead with Jan. 6 probe Democrats question GOP shift on vaccines 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 PaulSenators reach billion deal on emergency Capitol security bill GOP Rep. Cawthorn says he wants to 'prosecute' Fauci Writer: Fauci, Paul clash shouldn't distract from probe into COVID-19 origins 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 CollinsOvernight Health Care: CDC advises vaccinated to wear masks in high-risk areas | Biden admin considering vaccine mandate for federal workers Eight Republicans join Democrats to confirm head of DOJ environmental division The Hill's Morning Report - Presented by Facebook - Crunch time for bipartisan plan; first Jan. 6 hearing today 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 PortmanBiden, Sinema meet as infrastructure talks hit rough patch Feehery: It's time for Senate Republicans to play hardball on infrastructure The Hill's Morning Report - Presented by Facebook - Crunch time for bipartisan plan; first Jan. 6 hearing today MORE (Ohio) and Shelley Moore CapitoShelley Wellons Moore CapitoOfficials warn of cybersecurity vulnerabilities in water systems Graham, Hawley call on Judiciary Committee to hold hearing on US-Mexico border GOP senators urge Biden to keep Trump-era border restrictions 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.