Too many cooks threaten GOP healthcare bill

Senate Republicans may have too many cooks in the kitchen when it comes to healthcare, and it’s complicating efforts to draft an ObamaCare replacement bill.

The main Senate group working on crafting healthcare legislation is the task force of 13 men backed by Senate leaders. It won negative attention early on for its lack of women, at which point GOP leaders opened it up to all members.

There’s also a rival group led by Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine), who have been outspoken opponents of the House-passed American Health Care Act and co-sponsored their own version of an ObamaCare replacement bill called the Patient Freedom Act.

{mosads}Yet another group is led by Sen. Rob Portman (R-Ohio) and is focused on Medicaid expansion.

And then there’s the faction of conservatives that includes Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah). They’re not a formal working group, but they want the Senate bill to be as close as possible to the House bill.

That’s to say nothing of members from the House trying to weigh in on the process, GOP governors, who some senators say should have a larger role, and the Trump administration.

Republican senators appear to be aware of the potential problems.

“The only way of doing this, you can’t have 52 people drafting the bill,” Sen. Ron Johnson (R-Wis.) recently told The Hill about the challenges faced by his conference.

The competing interests come amid increasing pessimism from GOP senators that they’ll arrive at a deal.

Republicans have little room for error. They can lose only two votes and get a bill out of the Senate, assuming united Democratic opposition.

Prior to this week, most senators were saying publicly they expected a vote by the August recess. But even that date is now being questioned. Senate Majority Leader Mitch McConnell (R-Ky.) has sounded skeptical that he can get the necessary 50 votes to pass a bill.

Senators haven’t been able to overcome the major differences that have plagued the repeal effort from the start. There’s no consensus on how to roll back Medicaid expansion, Medicaid spending levels or ObamaCare insurance regulations.

Senate leadership staff spent the recess writing draft language for senators to look at this week, using input from the meetings of the primary working group.

But according to a source familiar with the process, it’s not being presented as legislative language. Instead, it’s merely a collection of different ideas, proposals and decisions that still need to be made.  

Republican leaders are grappling with how to unite a party divided on multiple fronts, and the working group dynamic has made negotiations difficult.

“There are so many [working groups], and they’re focused on too many different components. It’s an anomaly,” one former Senate Republican aide said. “It makes it harder to get to a final product. When you have all these groups and members out there, it’s hard to get to a consensus.”

According to some former Senate staffers, part of the problem is that leadership decided early on to conduct its work outside of the normal committee process because it wasn’t going to be bipartisan.

“You have warring ideas within a committee, too. What’s unusual is for policy matters to completely bypass the key committees,” said John McDonough, a former senior adviser to the Democratic-led Senate Health, Education, Labor and Pensions Committee during the passage of ObamaCare.

“Usually, committees are very covetous of their influence and rebel against any effort to erode that authority,” and that isn’t happening here, McDonough said.

Without formal committee hearings or listening sessions, senators who would normally be involved in the decisionmaking process are suddenly finding themselves on the outside. So to make sure they have a voice, they’ve formed working groups.

On the flip side, senators such as Cruz and Lee who aren’t on the Health committee now have seats at the table.

“You wouldn’t have the same incentive to create these spin-off groups and special coalitions and working groups if you went through committees,” said Bill Hoagland, a vice president at the Bipartisan Policy Center and former director of budget and appropriations for the Republican Senate majority leader from 2003 to 2007.

Having a fragmented Republican caucus “definitely adds to the difficulty of getting to a consensus and agreement,” Hoagland said.

If progress is made, it’ll likely be done through the original McConnell-backed group.

“If the group of 13 comes up with something, all the other groups will fall away,” Rodney Whitlock, former acting health policy director for Sen. Chuck Grassley (R-Iowa), said.