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The conservative health care problem

Cliff Owen / AP

Even before the Senate health care bill is released, conservatives already want to amend it. Sen. Ted Cruz may try to amend the bill to let insurers sell health plans that don't comply with Affordable Care Act rules — but Majority Leader Mitch McConnell may not let him, because he doesn't want any Republican amendments.

Why it matters: It's unclear whether that's going to be a problem for conservatives like Cruz or Sen. Mike Lee, but the House Freedom Caucus wants it included in what the Senate sends back over to the House. And that could affect the chances of a final version getting through the House, even if the Senate can pass it.

What the policy would do: Dubbed the Consumer Choice Act, the policy would allow insurers that sell Affordable Care Act health plans on the exchange to also sell any state-approved plans that don't meet ACA standards. People purchasing those plans could use their premium subsidy to do so, unlike under current law.

Cruz has been promoting the idea, but he wouldn't comment when I asked him about it this morning, and his office didn't respond to a request for more information.

The Freedom Caucus really likes this idea: Chairman Mark Meadows, who helped craft the amendment that eventually got the House bill passed, told me this:

"Obviously the main driver for the Freedom [C]aucus is driving down premiums, and if the MacArthur amendment is taken out...then we would look for other language to address the issue. Senator Cruz has the consumer choice amendment that could bring a number on moderates and conservatives to consensus if it is included. This is a work in progress and we are prepared to remain at the table until we get it done."

(The so-called MacArthur amendment, which would allow state waivers of the ACA's essential health benefits and ban on charging sick people higher premiums, will not be in the Senate bill.)

The problem: ACA plans would undoubtedly be more expensive — and comprehensive — than non-ACA plans. If subsidies could be used to purchase both, healthy people would likely flock to the skimpier, cheaper plans, leaving only sick people with the beefier plans. That could drive premiums up for sick people and cause market instability.

What we're watching: Whether this policy — or any other GOP amendments — can be offered during next week's vote-a-rama. If it can't, it's unclear how conservatives will react. Cruz "has been very crafty and not boxing himself in one way or the other," said a senior GOP aide.

To be signed into law, the House could be forced to vote on the Senate-passed bill without the opportunity to make changes.