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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.

Go deeper

45 mins ago - Health

U.S. tops 88,000 COVID-19 cases, setting new single-day record

Expand chart
Data: COVID Tracking Project; Chart: Axios Visuals

The United States reported 88,452 new coronavirus cases on Thursday, setting a single-day record, according to data from the COVID Tracking Project.

The big picture: The country confirmed 1,049 additional deaths due to the virus, and there are over 46,000 people currently being hospitalized, suggesting the U.S. is experiencing a third wave heading into the winter months.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Health: Large coronavirus outbreaks leading to high death rates — Coronavirus cases are at an all-time high ahead of Election Day.
  2. Politics: Top HHS spokesperson pitched coronavirus ad campaign as "helping the president" — Space Force's No. 2 general tests positive for coronavirus.
  3. World: Taiwan reaches a record 200 days with no local coronavirus cases.
  4. Sports: MLB to investigate Dodgers player who joined celebration after positive COVID test.
  5. 🎧Podcast: The vaccine race turns toward nationalism.

The norms around science and politics are cracking

Illustration: Aïda Amer/Axios

Crafting successful public health measures depends on the ability of top scientists to gather data and report their findings unrestricted to policymakers.

State of play: But concern has spiked among health experts and physicians over what they see as an assault on key science protections, particularly during a raging pandemic. And a move last week by President Trump, via an executive order, is triggering even more worries.