Moderate vs. conservative: What health care bill will come out on top?

The House’s health care bill, known as the American Health Care Act (AHCA), took some major steps forward over the past several weeks. It passed the House, after the addition of two crucial amendments—the MacArthur Amendment, which allows states to opt out of essential health benefits and community ratings, and the Upton Amendment, which allocates an extra $8 billion to high risk pools—and is now under review in the Senate. The Congressional Budget Office’s (CBO) recent score of the AHCA was similar to scores of previous iterations of the bill: premiums would rise, the uninsured population would increase, and the deficit would decrease. 

Despite recent progress, the bill has a long way to go—and many changes to face—before it makes its way into law. Right now, Senate Republicans are taking their turn with it, making revisions and consulting with the CBO, and they’re optimistically predicting it will be ready for a vote before the July 4 recess.

One pressing question about these changes: Which direction will the bill ultimately swing—further right, or more toward the center? The conservative and moderate factions of the Republican Party had significant disagreements in the House, and these will undoubtedly continue as Senate Republicans work on rewriting the bill. But which group will actually come out on top? We decided to take a look.

On the conservative side …

Conservatives’ wish list for health care reform is essentially a full repeal of the Affordable Care Act (ACA)—even provisions that have proven popular among the public. This would include rolling back the protections for pre-existing conditions, completely throwing out the essential health benefits, and rolling back Medicaid expansion as soon as possible.

That conservative agenda isn’t favored by most Americans, but there are a few elected officials from districts or states that are more than enthusiastic about this path. In the House, those lawmakers included the Freedom Caucus, a major player in holding up the first draft of the AHCA. In the Senate, there are three main players: Rand Paul of Kentucky, Mike Lee of Utah, and Ted Cruz of Texas. Despite their small numbers, three votes would be just enough to sink the bill in the Senate.

One advantage that conservatives have is that the constituencies they represent are extremely supportive of their particular hard-line repeal policies. They aren’t in any danger of a challenger when the 2018 elections roll around, so they’re unlikely to yield. This is part of the reason the MacArthur Amendment, which rolled back a lot of pre-existing condition protection, was enough to push the House to a successful vote, despite its unpopularity with the public.

Conservatives have little to lose, but an unpopular agenda. It will be hard to dissuade them from blocking a vote, but harder to get all of their unpopular policies past the Senate and the conference committees, as these bodies tend to be more moderate.

Meanwhile, the moderates …

Moderate Republicans are more likely to be from states that accepted Medicaid expansion under the ACA—and thus are reluctant to see it go, lest their constituents lose coverage. They’re less clear about their overall hopes for the bill. Mostly, they want to cut costs without drastically cutting coverage—a hard line to draw. On other issues, their preferences range widely, making it difficult to hammer out a bill that appeases every request from everyone on the moderate spectrum.

Unfortunately, many moderate Republicans are likely to be at risk next reelection cycle if they misstep—meaning that they may not be as forward with their demands as their conservative counterparts. If it comes down to voting for an “OK” bill versus not voting at all, moderates could be more likely to vote for it rather than fight for their specific policies, simply to show that they are fulfilling their campaign promise of health care reform.

One thing that moderates have going for them is that, if they were to loosen their insistence that the ACA must be “repealed and replaced” rather than “repaired,” they may be able to garner some bipartisan support for their ideas, easily overcoming any threats from conservatives saying they’ll vote no. However, bipartisan support will be difficult to achieve with party tensions at an all-time high.

While the House had its own problems getting moderate Republicans on board, the Senate is far more moderate than its counterpart—meaning that without bipartisan support, it’s unlikely the two chambers will be able to agree on a bill, even if they are able to pass their separate versions.

The fork in the road

In all likelihood, the final version of the law (should it ever make it that far) will probably be a more moderate one than the AHCA that passed the House by the skin of its teeth. Whatever the case, it’s going to be tricky—neither side of the Republican Party has enough support on its own to get through both chambers of Congress, and both chambers seem to want totally different things.

One thing that will probably appear in either version of the bill? Some kind of reporting requirement. If Republicans plan to instate their own health care plan, whether it’s a conservative or moderate one, odds are some kind of reporting will have to occur to make sure the new health care laws are being followed. They may be less stringent under a conservative bill, but many of the same aspects would still be in place.

Either way, make sure to keep up on your data collection as the year proceeds—moderate, conservative, or bipartisan, it’s going to take a long time to make a bill into law.