The way the power struggle plays out could affect the leadership of key committees for healthcare issues such as Ways and Means and Energy and Commerce. “There is kind of the domino effect,” said Joseph Antos, a health policy expert at the conservative American Enterprise Institute.
While Cantor's defeat has been widely blamed in part on his failure to take a sufficiently hard line on immigration matters, healthcare likely also played a role in angering conservative activists in his district. Independent Women's Voice, which has been pushing candidates to sign a pledge to repeal Obamacare, issued a news release pointing out that Cantor's victorious opponent, college professor David Brat, had signed the pledge, while Cantor had not.
"The voters in Virginia were paying attention to candidates who take a stand against Obamacare,” said Heather Higgins, president and CEO of Independent Women's Voice, in a statement. “After tonight, every Republican incumbent will be paying attention as well."
That sort of obstinacy among the GOP base could make it difficult for Republicans to garner votes for even minor changes to the federal healthcare law. For example, America's Health Insurance Plans, the primary industry group, is advocating for allowing individuals to use federal subsidies to purchase catastrophic plans, a practice that is currently prohibited.
Cantor has been a proponent of moving beyond simply voting to repeal Obamacare and putting House Republicans on the record backing an alternative. But the substance of such a plan has so far failed to materialize because of ongoing debate within the GOP caucus.
“Even before the outcome of last night's election there were a lot of questions about whether or not to go forward in the House with some type of alternative and what the exact shape of that would be,” said Dean Rosen, a former top GOP staffer on healthcare issues and now a partner with the lobbying firm of Mehlman Vogel Castagnetti. “Leadership in general was certainly testing the waters.”
Conservatives have been pushing for a vote on a proposal put forth by Rep. Phil Roe (R-Tenn.)—who is a physician—that would expand the use of health savings accounts, allow health plans to be sold across state lines and overhaul medical malpractice laws. A chief proponent of moving forward with a proposal along those lines has been Rep. Steve Scalise (R-La.), chair of the conservative Republican Study Committee, which more than two-thirds of GOP House members belong to. Scalise is now running for House whip, the third most powerful post in leadership, which could elevate his influence on how the House proceeds on healthcare issues.
Moving forward with any substantial repeal-and-replace proposal, though, has raised concerns that it would unnecessarily create a target for Democrats ahead of November's elections. That's in large part because the Democratic-controlled Senate is certain to ignore the legislation.
And as one Republican healthcare lobbyist pointed out, speaking on the condition of anonymity, it's not going to placate far-right activists anyway. “The tea party folks by and large don't give a crap about replace,” this person noted. “They just hate the law.”
Whatever course House Republicans choose on healthcare policy, it will be with an eye squarely on the November elections, according to Eric Zimmerman, a partner with the law firm McDermott Will & Emery, which closely tracks healthcare issues. “They were going to move forward with something anyway,” Zimmerman said. “Regardless of what they do it's just political positioning for the upcoming election.”
At Wednesday's news conference, Cantor cited healthcare policy as among the key accomplishments of House Republicans during his tenure. “We've fought to protect people from losing their insurance or facing higher healthcare costs due to Obamacare,” he said.
He also insisted that the final two months of his tenure in the leadership post would not be ineffectual despite his lame-duck status. “There's a lot of things in motion,” Cantor said. “We will continue to work.”
Follow Paul Demko on Twitter: @MHpdemko