Familiar Divisions Emerge as Senate GOP Works on Healthcare Bill

The version of the American Health Care Act that was passed by the House last week is unlikely to bear much resemblance to what Republican senators hope to eventually pass in their chamber of Congress — but the dynamics of the intra-party debate could be a mirror image of the debate that preceded it.

While the 12-member working group composed of GOP Senate leadership plus notable conservatives and moderates work to develop a plan of their own, lawmakers who find themselves on the outside of that group will be carrying out a similar give-and-take to what the conservative Freedom Caucus and moderate Tuesday Group went through to pass the AHCA in the House.

The moderate wing of the Senate GOP will find its voice with Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME), two of the party’s more moderate senators who released their own plan to reform the nation’s healthcare system earlier this year. Their bill gives states the choice of keeping Obamacare’s mandates in place or developing an alternative with or without federal assistance, and elements of it could end up in the Senate’s final version of the bill.

That flexibility could help keep Republicans on board who represent states that expanded Medicaid — Sens. Shelley Moore-Capito (WV), Dean Heller (NV), and Jeff Flake (AZ) to name a few. Given that the GOP can only afford to lose two votes from its 52 senators, building consensus will be crucial.

Consensus, though, can be hard to come by in Congress. Conservatives like Sen. Rand Paul (R-KY), who called the House-passed version of the AHCA "deplorable," take issue with its continued subsidies for premiums and want to see those phased out. Paul drafted his own bill to repeal and replace Obamacare earlier this year, which earned the endorsement of the House Freedom Caucus.

How quickly the Senate GOP can find middle-ground on the bill remains to be seen, but even when the Senate does pass the bill Congress’s job likely won’t be done. If the Senate amends the House-passed bill, the version that passes the Senate will have to go conference committee so lawmakers from both chambers can resolve the differences.

Stay tuned.

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— Eric Revell

(Photo Credit: Gage Skidmore via Flickr / Creative Commons)