(Reuters photo: Joshua Roberts)

He pushes for a more conservative GOP bill but identifies possible middle ground.

As Senate GOP leaders push for a procedural vote this week on a draft bill to reform the Affordable Care Act, one Republican has expended particular energy pushing for conservative modifications that he believes would make the bill a true repeal-and-replace effort.

Texas senator Ted Cruz has not been deterred by the partisan infighting over health care. He has instead taken an active role in developing a version of the bill that can secure the necessary votes to reform President Obama’s signature legislative achievement.


Just after the GOP draft was unveiled last week, Cruz released a joint statement — with fellow Republican senators Mike Lee (Utah), Ron Johnson (Wis.), and Rand Paul (Ky.) — saying he would vote “no” on the bill as it stood. All four said they remain “open to negotiation and obtaining more information before it is brought to the floor.”

Cruz said in a subsequent statement that he was pleased with some aspects of the draft, including its expansion of association health plans and its reduction of Medicaid’s growth in coming years, but he believes that the current bill wouldn’t be able to substantially lower premiums, which, in his mind, is the primary goal of reform.

Like the hardline conservative members of the Freedom Caucus in the House, Cruz believes that the GOP needs to do more than simply tinker around the edges of Obamacare to provide relief to Americans who have experienced skyrocketing premiums and lost coverage options as the result of insurance companies’ pulling out of state markets.


“I want to get to yes, but this first draft doesn’t get the job done,” Cruz said last week. “Over the next week and beyond, I will continue working to bring Republicans together to honor our promise, repeal Obamacare, and adopt common-sense, consensus reforms that can actually be passed into law.”

Cruz sees the Consumer Freedom Amendment as the best of both worlds, leaving existing Obamacare plans intact while encouraging insurance companies to provide more-affordable plans.

And Cruz has been as good as his word, doing much more than simply voicing discontent and then sitting back to let others fight it out. Shedding his reputation as one of the Senate’s most contentious members, he has already suggested one possible middle-ground compromise: an amendment allowing insurers to offer some plans that don’t comply with Obamacare’s mandates, as long as they maintain at least one plan that does conform to the requirements.


In Cruz’s view, this Consumer Freedom Amendment would be the best of both worlds, leaving existing Obamacare plans intact while also encouraging insurance companies to provide a number of more affordable plans. This solution would preserve low-cost options for those who have seen their costs increase exponentially, while still covering Americans who didn’t have health insurance before the mandates of the Affordable Care Act went into effect.


Cruz wants to see a revised draft that creates a 50-state marketplace to provide more health-care options, expands health savings accounts, caps punitive damages in medical-malpractice lawsuits, and allows states to develop innovative solutions to increasing Medicaid costs.

His compromise efforts go back to several months ago, when he established a working group of conservative and moderate Republicans who meet weekly in his conference room to discuss health-care reform. Cruz’s conciliatory tone on this draft has clearly evolved from his desire to take a new approach after the election of Donald Trump, and he has made himself an important player as a potential bridge between moderate and more-right-wing Republicans in both the Senate and the House.


Since last Friday, Republican Dean Heller of Nevada and Susan Collins of Maine have joined Cruz, Lee, Paul, and Johnson in dissenting from the current draft. The objections of Heller and Collins reflect the biggest problem facing the GOP in trying to pass Obamacare reform. Conservatives such as Cruz believe that large parts of the ACA’s existing structure must be jettisoned, but moderate Republicans such as Heller are concerned that the GOP bill might go too far in cutting Medicaid and other provisions of Obamacare, which could result in low-income Americans losing their health-care plans.

Four Republican senators have yet to announce officially where they stand on the bill: Rob Portman (Ohio), Lisa Murkowski (Alaska), Shelley Moore Capito (W.Va.), and Bill Cassidy (La.). All four have said in the past that they would oppose legislation that drastically cut Medicaid or would cause Americans to lose the health insurance they had gained as the result of Obamacare.


Senate majority leader Mitch McConnell has given every indication that he intends to bring the bill to the floor for a procedural vote this week, but with the six definite “no” votes and four on the fence, it’s difficult to see the bill moving forward before the July 4 recess. If the bill does fail to reach the next stage of debate this week, Cruz will surely be one of the chief proponents of a second effort, this time focused on significantly more-conservative reforms.

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