By Rachel Roubein - 07-05-17 06:00 AM EDT
The fate of of legislation repealing and replacing ObamaCare could hinge on an amendment from Sen. Ted Cruz.
The Texas Republican is pushing for a provision that would allow insurers to sell plans that do not comply with ObamaCare insurance regulations, so long as they also sell plans that comply with those rules. Cruz says giving insurers a path around the regulations should allow them to offer some plans at a lower cost.
It's unclear whether the amendment will be added to the Senate bill, known as the Better Care Reconciliation Act, or even whether it will pass muster under budgetary rules.
But the amendment could be the key to ensuring that the legislation passes both the House and the Senate.
House Freedom Caucus Chairman Mark Meadows (R-N.C.) indicated he could support the Senate bill if the Cruz amendment is included. That's different from a little more than a week ago, when Meadows said the Senate's legislation lacked enough conservative support to pass the House.
"If the Cruz consumer choice amendment gets there, yes I can support it without the MacArthur amendment in there because I think it gives everybody some options," Meadows told reporters late last week.
Leaders have sent two versions of a revised Senate healthcare bill to the Congressional Budget Office - one with the Cruz amendment and one without it, a GOP aide confirmed to The Hill.
The text of Cruz's amendment hasn't been publicly released, but the goal is for the plans that don't adhere to ObamaCare's insurance regulations to be cheaper than those that do.
For many conservatives, lowering insurance premiums is key.
It wasn't easy to net conservatives' support in the House for the healthcare bill, as it took weeks for the ultraconservative Freedom Caucus to come on board.
Leadership couldn't pass the bill without Freedom Caucus votes and eventually won their support after the addition of a controversial amendment from Rep. Tom MacArthur (R-N.J.). That amendment would let states apply for waivers to opt out of certain core ObamaCare insurance requirements, such as a ban from charging sick people more and the requirement that they cover a list of "essential" services, such as maternity care and mental healthcare.
Meadows suggested the Cruz amendment would be an acceptable substitute for the House's MacArthur amendment.
"Right now I'm looking at the Cruz consumer choice amendment as the primary vehicle that makes the most sense to me," Meadows said, "and I applaud him for stepping out."
The Cruz amendment could also help get the vote of Sen. Mike Lee (R-Utah), who quickly came out in opposition to the Senate bill in its current form, in part because it doesn't lower the cost of consumers' healthcare enough.
In an analysis of the Senate bill, the nonpartisan Congressional Budget Office estimated premiums would be 20 percent higher in 2018 and 10 percent higher in 2019. Then, in 2020, premiums would drop 30 percent lower than under ObamaCare.
In a June 23 Medium post, Lee wrote that "for all my frustrations about the process and my disagreements with the substance of [the Better Care Reconciliation Act], I would still be willing to vote for it if it allowed states and/or individuals to opt-out of the Obamacare system free-and-clear to experiment with different forms of insurance, benefits packages, and care provision options."
But the Cruz amendment risks alienating Senate moderates, who want to keep the protections for pre-existing conditions in place.
"It hasn't been fleshed out yet, so I believe pre-existing conditions ought to be covered, and we shouldn't deny people coverage with pre-existing conditions, so that would have to be worked out," Sen. Rob Portman (R-Ohio) said Thursday of Cruz's proposal. "There are a lot of moving parts."
Moderates are also concerned about the bill's Medicaid provisions, as it contains deeper cuts to the program than the House bill starting in 2025 and phases out federal funds for ObamaCare's Medicaid expansion over three years, beginning in 2021.
For the Cruz amendment, there's another potential problem: The bill might not meet the strict requirements of reconciliation, the fast-track budget maneuver Republicans are using to repeal and replace ObamaCare because it avoids a Democratic filibuster.
Conservative senators and GOP leaders met with the Senate parliamentarian - who serves as the referee on what provisions meet reconciliation's guidelines - late last week to discuss the amendment, a sign leadership is taking Cruz's proposal seriously.
"We're trying to help figure it out because there's a lot of support for what he's trying to do," Senate Majority Whip John Cornyn (R-Texas) said a few hours after the meeting.
Other conservative groups like the amendment.
"These are the types of reforms that would help roll back the damage inflicted by Obamacare," Heritage Action CEO Michael Needham said in a statement. "Simply throwing more money at the problem as some moderates are seeking to do is not an enduring solution."
Though FreedomWorks won't throw its support behind a bill that doesn't fully repeal ObamaCare, the Cruz amendment would make the bill better, said Jason Pye, the group's vice president of legislative affairs.
"It provides individuals a choice and that should be part of the goal," Pye said.
Pye added that because the Senate bill doesn't fully repeal ObamaCare, "it's a betrayal of everything we've been told the past seven years," but he said that the amendment would help FreedomWorks take a "supportive posture" to the extent it could without key voting the bill, which it won't do.