Over the past several years the conservative wing of the GOP has flexed its considerable clout. From Sequestration to the Fiscal Cliff to the Government Shutdown to pushing out Speaker Boehner, conservative members have pushed their party to take a hard right stance on many, many issues.
With control of all levers of government they are not letting up. The so called Freedom Caucus, a group of about 30 conservative lawmakers, killed the first version of the AHCA when they decided the bill did not repeal and replace Obamacare.
Depending on how you look at it, the revised AHCA is a victory for the Freedom Caucus and its power. The only reason the bill came back up was because Paul Ryan and President Trump gave into many of the Caucus’s demands. Most significantly, the new bill would let states opt out of many of the ACA’s most significant requirements.
But, this caused another headache for leadership and reflected the power of a rising group of Republicans, the Centrist/Moderate wing of the party. When leadership gave into Freedom Caucus demands they lost a dozen fence sitting moderates. The bill was unacceptable to members who wanted to protect the least fortunate.
As a result, leadership and conservatives had to huddle with moderates to carve out concessions for a number of them (including $8 billion in new funding to support coverage for people with preexisting conditions). If the House was just the teaser for moderates power, the Senate is where they will determine the future of the law.
The bill is still more conservative than not. Medicaid Expansion is repealed in two years (unless states can fund it), mandatory coverage for preexisting conditions is gone and moderates could only get a billion dollar slush fund in concession. That said, moderates made sure states had to apply for a waiver to opt out of the ACA’s essential coverage requirements and they also were instrumental in passing the law. Moderate Republicans are not fans of the law, but they made sure their voices were heard in the process. Ultimately, they might have shaved some of the roughest edges off the law for the Senate.
Moderates did not just show clout on healthcare recently. On the budget deal, moderates took the lead in negotiations and eliminated poison pills out of the final package. They sidelined contentious issues like cuts to HUD and building a border wall and instead focused on increased spending for the military and border security. Quietly, moderate leadership told the White House a lot of what they wanted to do to Sanctuary Cities and Planned Parenthood could be done administratively.
Moderates might have had their biggest success on Trump’s Religious Liberty Executive Order. The initial draft of the bill would have allowed organizations to “discriminate” (according to some) in hiring and other decisions based on sexual orientation. The EO released last Thursday simply makes it easier for religious institutions to engage in political activity (hint, they already do).
Already, in the Senate moderates are flexing their power. As soon as the AHCA passed in the House word spread the Senate would not vote on the House bill. Instead, a working group which has been in contact with House Leadership is crafting their own plan. This is not surprising considering statewide races in which Senators run are a different beast than smaller and more homogeneous Congressional districts.
Moderate concerns over the bill in the Senate reflect those of moderates in the House. Repealing Medicaid Expansion might cut off insurance access to those who are 138 percent or below the poverty line. That is huge because more than half of the people that did not have coverage before the ACA fell below that income level. While a majority of those still without insurance today are young and healthy, fully 30 percent have ongoing medical issues. Repealing Medicaid Expansion would only make it tougher for them to gain access to care, let alone insurance.
The uninsured are largely poor and young. Gaps in the law and court decisions have removed coverage requirements for millions of individuals. For example, millions reside in states that have not expanded Medicaid (my home state of Idaho being one). Additionally, the Supreme Court’s decision in 2012 to let states decide to expand Medicaid left millions in limbo and threw out the stick arm of the law.
This is not even including the millions who remain uninsured even with the ACA. Of course, the government says a majority can afford coverage (20 percent out of 29 million) but I doubt the government really knows what affordable is to a single guy living on $25K a year in a city.
Considering these factors, it is not surprising to see why moderates in the House and several GOP Senators balk at the House bill. By cutting back federal involvement in health insurance so sharply millions will likely lose coverage. It is easy to see why members would be concerned.
There is also the electoral component. The Daily Kos, the liberal cheer-leading arm, led off with a piece the other day about how so many moderates were endangered voting for the law. Of the Republicans sitting in Clinton districts, 14 voted yes to 9 who voted no. In fact, more Republicans sitting in Trump districts (11) voted no than Republicans in Clinton districts. Considering the impacts of this bill it is little wonder why liberals are cheering.
But, moderates might have/will save the day for their party. By changing the House bill the Senate might give the GOP a fighting chance to argue the bill does in some form protect the least fortunate. Additionally, the Senate crafting a different and revised version might be just enough to allow the party to win over more of the public and piece together a conservative/moderate majority in the House/Senate on the piece of legislation.
Time will tell, but right now moderates are increasingly showing their clout on healthcare and other issues. Who says centrism* is dead?
Note: Centrism today is a lot different from past electoral cycles.