Cliques in Congress

Just like any large organization, you’ll find different factions in Congress that stick together on particular issues or ideology – and regardless of what you call them, they’re cliques. While some are obvious: Republicans and Democratic parties, others are less so, but still play an important part in policy making.

The latest round of federal health care policy votes has been heavily influenced by groups you may not have heard of before.  Understanding who they are and what they are ultimately asking for when it comes to healthcare is crucial when you advocate.

Now that the new Republican Congress has taken its first concrete steps to repeal the Affordable Care Act (ACA), also known as Obamacare, we can take a look at where the different factions – or cliques – of Congress landed in the House and how things may work out in the Senate.

The Tea Party and the Repeal Pledge

The Affordable Care Act was signed into law in March 2010 and there was some debate among Republicans over how to react.  Some Republicans suggested that it might be time to accept the law as permanent and work to move it in a more conservative direction.  These Republicans that dared suggest keeping the law were attacked mercilessly by various “Tea Party” groups that sprang up to demand less government involvement in health care.  As a result, the 2010 election created a crop of new Republicans that were lockstep in their commitment to “repeal and replace” Obamacare.

These winners were once viewed as extreme, but the Republicans of 2010 are mainstream names leading in Congress or the Administration today, like Marco Rubio, Senator from Florida; Rand Paul, Senator from Kentucky; Nikki Haley, Governor of South Carolina; and Kelly Ayotte, Senator from New Hampshire.

By 2012, promising to repeal Obamacare was a requirement for every Republican.  Mitt Romney, who had passed a law like Obamacare in Massachusetts, made the repeal pledge while running for President.  Republicans across the spectrum made the same promise in 2014 and 2016.


Today, Congress no longer has an active Tea Party caucus, but the group’s issues are still driving the day.  Its legacy was a Republican party in control of the House, Senate, and White House that all pledged to repeal Obamacare but had no idea how.

The Freedom Caucus Carrying the Torch

As the Tea Party caucus was diminished in the House in recent years, it was replaced on the far right by the Freedom Caucus.  This group was formed in 2015 with a desire to take a more aggressive stance in negotiations with then-Pres. Obama.  The Freedom Caucus is largely seen as the reason House Speaker John Boehner retired, after the group constantly tried to force government shutdowns to accomplish their goals.  The group tends to be more libertarian than the Tea Party was, but a number of the individuals in the group have political ties to Pres. Trump.

In the ACA repeal effort, Speaker Paul Ryan can only afford to lose about 22 votes and there are about 35 members in the Freedom Caucus.  The group generally votes together and therefore they have veto power over anything House Republicans want to do.  The Freedom Caucus blew up the first repeal effort, but ultimately the group delivered 34 votes.  The group’s leader, Rep. Mark Meadows (R-NC), was instrumental in negotiating the deal that allowed the Obamacare repeal to pass the House and he is now a leading figure in the Senate debate.

The Tuesday Group On the Other Side

On the more moderate side of the Republican caucus, there is a group of about 50 members that began gathering on Tuesdays back in 1994 in the wake of that year’s conservative takeover of the House.  The group is far less coordinated than the Freedom Caucus, and as a result, they are somewhat less powerful because the group can be more easily split.

Tuesday Group member Rep. Tom MacArthur (R-NJ) worked with the White House and Freedom Caucus members to broker the deal that eventually led to the House-passed bill.  While the Freedom Caucus voted for the repeal bill almost unanimously, the Tuesday group splintered with most of the 20 Republican “no” votes coming from the Tuesday Group but most group members voting for the repeal.

The Senate Working Group

Now the Senate Republicans will be tasked with finding a coalition to pass a health reform package, and they have said they will start from scratch with a new bill drafted by a 13-man (zero women) working group.  Factions are less important in the Senate, where any one Senator has tremendous power.

The working group includes the Senate leaders, key committee chairmen, and two leading conservative voices, Ted Cruz of Texas and Mike Lee of Utah.  This suggests the goal is to craft a bill that has a chance of passing but must be approved by hard-line conservatives.

The repeal bill is designed to pass on a 50-vote margin, but even so, Republicans can only afford to lose two Senators.  Only two Republican Senators are facing particularly tough battles in the next election, Sen. Dean Heller (R-NV) and Jeff Flake (R-AZ).  If they refused to sign on, the margin for error would be gone and a moderate senator like Sen. Lisa Murkowski (R-AK) or Susan Collins (R-ME) could kill the bill.  Sen. Collins is one to keep an eye on because she is already calling for a bipartisan bill.

Will Democrats Even Matter?

Right now, Democrats are united in their opposition to anything the Republicans have considered.  No democrats even came close to voting for the House bill.  That may not always be the case, however.  Many Democratic Senators face tough reelection battles in states that Pres. Trump won, and several moderate Senators have at least suggested they may be open to Obamacare changes.  This includes Senators like Claire McCaskill (D-MO), Angus King (I-ME), Heidi Heitkamp (D-ND), Joe Manchin (D-WV), and Jon Tester (D-MT).  All have said they oppose a repeal bill, however, so as long as Republicans are going down that path there will likely be no participation from Democrats.

What Can We Do?

Don’t think your voice doesn’t matter. With 29.1 million Americans with diabetes, we are a very large and powerful clique. Anyone with a preexisting condition like diabetes must let their Senators know (Republican or Democrat!) that this bill as it stands will not protect those with diabetes.

You can do this easily by downloading the DPAC App. When you log in, you’ll be able to tweet/email/and call your Senators to let them know you are a voter and that your voice matters.