Four years ago, Mike Lee and Ted Cruz launched an all-out media blitz to stop Obamacare implementation that culminated in a 16-day government shutdown. Now the conservative senators are still pressuring GOP leaders to go further than their colleagues in gutting the law, but they’re making their push through quiet backroom conversations instead.

It’s a shift for the Senate GOP’s two leading agitators, who are trying to build consensus in their own unique, hard-line way. And where they end up will ultimately determine whether Republicans are able to pass a bill.


If Lee and Cruz are able to help craft a compromise that can win 50 Republican votes, their support will go far in easing concerns from other conservatives who still deride the bill as Obamacare-lite. Yet the firm positions of Cruz (R-Texas) and Lee (R-Utah) are still imperiling the Senate Republicans’ repeal effort by pushing the party more to the right than many more centrist lawmakers would like to go.

They are intent on slashing the law’s regulatory regime and pre-existing condition language, a political third-rail in the health care debate that’s caused several awkward encounters in party lunches, according to senators and aides. Sen. Lamar Alexander (R-Tenn.), who created the GOP's working group with Cruz, has now taken to pushing back against the duo at party meetings, speaking on behalf of the majority of the caucus, those sources said.

Cruz and Lee also played an integral role in halting Senate Majority Leader Mitch McConnell’s quick strike plan to pass a bill and avoid a recess facing the bill’s many critics. But they are operating with a greater goal in mind: creating a bill conservative enough to quickly pass the House and avoid dragging out the party’s health-care battles any further.

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“It’ll make it much easier for conservatives in the House” if they succeed, said Rep. Mark Meadows of North Carolina, the House Freedom Caucus chairman and an ally of Lee and Cruz. “Really, the greatest flux you have with getting 218 in the House is probably more with conservatives than it is moderates.”

However, the exact nature of the policies they are pushing may be both politically and procedurally impossible to achieve. The Consumer Freedom Act that they are advocating would create parallel health insurance markets in states, with one containing protections for people with pre-existing conditions and another that would allow the sale of plans outside Obamacare’s regulatory regime, likely with no subsidies.

That would drive down premiums for many young and healthy people and increase coverage numbers for them — and get Republicans closer, in their mind, to fully dashing the law.

“We’re very proud to see these folks leading the way toward real repeal,” said Ken Cuccinelli, president of the Senate Conservatives Fund.

But there are fears among Republicans and policy analysts that such a setup would result in a “death spiral” for insurance markets and hurt support for the bill both in and outside the Capitol.

“What that will do is allow insurers to offer cheap policy to young invincibles. And on the exchange you’re going to get all the sick people,” said Douglas Holtz-Eakin, a former Congressional Budget Office director and president of the American Action Forum. “That’s a recipe for a meltdown. You’ve split the risk pool into two exchanges.”

And, he added: “I think it would end up being bad politics.”

Perhaps what’s most notable about the latest collaboration between Cruz and Lee, who are close friends and aligned on most issues, is how they are going about it. They aren’t firebombing McConnell on TV or on the Senate floor after many tangles with him in the past, but instead are intent on using their status as conservative negotiators inside the room as part of McConnell’s working group.

“We are making steady progress towards bringing the conference towards agreement,” Cruz told reporters on Thursday after one of many private meetings with McConnell. “I’m hopeful we can come together.”

Cruz in particular is seen as a constructive presence after years of fighting McConnell at every step of the way.

“He’s been an honest broker in this whole process. It’s new, but it’s good,” said Sen. Dean Heller (R-Nev.). Heller would not say, however, whether it was possible for him, Cruz and Lee to all support the same bill.

Lee has been a little more prickly, saying he shares constituents’ frustration with the “lack of transparency” of how the bill is being written. And Republicans are more worried about getting his vote than Cruz’s, given Lee’s critiques of the party’s direction in private meetings. Lee also just won reelection, while Cruz is up next year and eager to maintain support from the GOP grass roots.

But Republican leaders are trying to avoid reopening the party to criticism over pre-existing conditions, given that such protections poll well and health care centrists like GOP Sen. Bill Cassidy of Louisiana have emphasized strengthening such safeguards after the House bill was panned for allowing states to waive them.

Lee and Cruz want to capitalize on their long-held quest to dismantle President Barack Obama’s health care law. In a 2010 race, Lee triumphed after GOP Sen. Bob Bennett flirted with Democrats on bipartisan health care reform; Cruz won his seat on an anti-Obamacare platform and came to prominence as a top critic.

“We campaigned on repealing Obamacare for eight years. At a bare minimum we should allow those Americans who want to opt out of Obamacare to do so,” Lee said in a statement for this story.

Cruz and Lee met with McConnell’s staff to discuss their proposal in detail on Thursday before the Senate headed home. Republican insiders say it’s almost certain to lose more votes than it gains if it’s included in the repeal bill, but it’s also likely to be analyzed by the Congressional Budget Office over the recess, a key nod to the group.

The conservatives have also met with Senate Parliamentarian Elizabeth MacDonough in McConnell’s office; it’s not clear whether the parliamentarian will allow Cruz and Lee’s proposal under procedural rules.

“Things that are more policy than budgetary are really hard to get past the parliamentarian,” said Sen. Roy Blunt (R-Mo.), a member of the leadership team.

The central question for the GOP’s health care effort in the Senate is this: Will conservatives see it as a binary choice between keeping Obamacare and moving away from it, and vote for a bill that isn’t a complete repeal?

Sen. Rand Paul (R-Ky.) is unlikely to vote for the bill, unless President Donald Trump can pesuade him otherwise. If the GOP also loses Cruz and Lee, it can kiss the effort goodbye.

GOP leaders say they are optimistic conservatives will compromise.

“He’s always saying on this bill: ‘I want to get to yes.’ But obviously he’d like to move it in a more conservative direction,” said Senate Majority Whip John Cornyn (R-Texas) of Cruz. “When you have a conference as diverse as ours, how do you get 50 people on the same bill?”

Cruz has signaled to Republicans that he is open to concessions in his public statements. And an aide to Lee said he may vote for a bill that included more state flexibility if their efforts to create new deregulated insurance markets fell short.

As their co-negotiator, Ron Johnson of Wisconsin, said of achieving their priorities: “We have to be [flexible], because the process itself may make it impossible.”

Adam Cancryn, Josh Dawsey and Brent Griffiths contributed to this report.