House Speaker Paul Ryan more or less shunned the involvement of outside conservative groups when cobbling together his Trumpcare bill, attempting to limit input to the minimum in an effort to rush the thing through before people could be talked out of it. That did not go over well with the Kochs and their ilk, and they're demanding they be included now in the Senate's negotiations.
Betrayed is probably a good word to describe how conservative activist organizations like FreedomWorks, Club for Growth, Americans for Prosperity and Heritage Action felt earlier this year. As Ryan guided the writing of a health-care revamp they’d demanded for years, they say he didn't check in to see how they felt about it. […]
Now the ball’s in the Senate’s court, where conservative groups are pressing for a harder line measure that eliminates Obamacare’s Medicaid expansion faster or allows insurance to be sold across state lines.
Phillips told me that if Senate Republicans wrote a bill ending extra federal dollars for Medicaid expansion two years earlier than in the House bill—moving it up from 2018 to 2020—AFP would view that as a “major improvement.”
“That’s a big one, and we think it’s a reasonable request,” Phillips said.
Killing Medicaid faster is something that's going to be hard for McConnell to pull off, particularly now that "moderate" Republicans—from states that have Medicaid expansion—are splintering to meet with Democrats. If the handful of Republicans in that effort refuse to play ball with the Kochs and their demands, McConnell doesn't get his 51 votes.
That's a big if. Counting on any Republican to show any principle about anything is never a safe bet. But a few of these senators’ careers are on the line, so this time might be more real.