Passage of the House's health care bill gives the Patient Protection and Affordable Care Act repeal effort new life after months of wrangling, but key Republican senators are already pushing it aside to write their own bill with no clear timetable to act.
The narrowly passed House measure can't get anywhere near the 51 votes needed as is, even though Republican senators have insisted they're united on delivering on their seven-year vow to repeal and replace former President Barack Obama's 2010 health law. Instead, they say, they want to write their own bill.
Lamar Alexander of Tennessee, chairman of the Senate health committee; Rob Portman of Ohio; and Roy Blunt of Missouri, a member of GOP leadership, described the plan even as the House was celebrating passing its repeal after weeks of back-and-forth.
"We'll write our own bill," Alexander said in an interview, although he said senators would consider pieces of the House bill. "Where they've solved problems we agree with, that makes it a lot easier for us."
[INTERACTIVE: Compare new health care bill with Affordable Care Act]
The decision will delay the prospect of any repeal bill reaching President Donald Trump's desk. Before the failure of the House bill in March, Senate Majority Leader Mitch McConnell, R-Ky., had talked of taking it up and passing it in a week.
"At this point, there seem to be more questions than answers about its consequences," said moderate Sen. Susan Collins, R-Maine.
The House bill, which squeaked through the House on a 217-213 vote Thursday, became an even tougher proposition for the Senate with changes made in recent weeks to win over conservatives. Those revisions raised potential procedural hurdles and sparked new Republican concerns over how the measure would affect coverage of people with pre-existing conditions.
Trump was still riding the victory Friday morning, tweeting, "Big win in the House -- very exciting! But when everything comes together with the inclusion of Phase 2, we will have truly great health care!"
Quick Action Unlikely
Senate Republicans were downplaying expectations for quick action. And a senior White House official, speaking on condition of anonymity, said the administration is ready for a slower, more deliberative debate in the Senate, where the main sticking point is expected to be how to address the Affordable Care Act's expansion of Medicaid.
Chuck Grassley of Iowa, a senior Republican on the Senate Finance Committee, said it will take weeks or maybe months for the Senate to develop a plan because many lawmakers in the chamber haven't yet engaged on the issue.
"There hasn't been any health care discussion over here," Grassley said.
Vice President Mike Pence tipped to that notion on Sunday, when he said on NBC's Meet the Press that he hoped a final version from Congress would get to the president to sign "before the end of the year."
Grassley also said the Senate GOP's goal should be to attract some Democratic support, even though Republicans are trying to use expedited measures that would allow the bill to pass with only 51 votes.
"As I said with Obamacare, anything that affects so many people and such a big part of the economy should have a solution that can attract bipartisanship," he said. "Obamacare didn't achieve that."
Democrats will negotiate only "if this is about improvements, repairs, reforms, advances" to the Affordable Care Act, Sen. Tim Kaine of Virginia, the party's vice presidential candidate in 2016, said Friday on CNN.
Kaine added: "If it's just about politics, no, we're not going to participate in slashing health care for millions just to give tax cuts to the richest."
Alexander, whose Health, Education, Labor and Pensions Committee will play a major role in drafting the Senate version, is beginning to lay out his objectives for the eventual measure.
"Our goals are to rescue the people who won't be able to buy insurance in 2018, to lower premiums, to gradually move Medicaid to the states without pulling the rug out from people, and make sure that people that have pre-existing conditions are covered," Alexander said. "We're going to go to work on it."
Blunt said Republicans will look to see what they can take from the House version as they write their own measure but that before holding a vote they'll need to see estimates from the Congressional Budget Office for its cost and how it would affect insurance coverage.
Portman said a growing working group including himself, conservative Sen. Ted Cruz of Texas, and leadership and committee chairmen has been meeting about once a week to try to find a path to 51 votes.
"It's an attempt to write our own bill," he said. "We all have ideas and so do a lot of our colleagues, so let's get them all together."
The working group drew immediate criticism from Sen. Ron Wyden, D-Ore., who tweeted, "Convening a group of men behind closed doors to scheme how to make care worse for women is as gutless as it gets, SenateGOP."
Sen. Lisa Murkowski, a Republican from Alaska, who has been critical of the House bill, said Thursday that she hopes the Senate starts with "a clean slate."
Her focus is on cutting premiums and protecting the Medicaid expansion in her state far more than enacting all of the tax cuts in the House bill.
"In Alaska people are a lot more concerned with cost and access" than the tax cuts, she said.
Senators Voice Concerns
To get some kind of health care bill through his chamber, McConnell will need to unite moderate and conservative wings of the party that want to pull the measure in different directions.
The GOP controls the chamber 52-48, meaning he can lose no more than two Republicans and still pass it, given the united Democratic opposition. The vice president can break a tie vote.
A number of moderates were unhappy with a Congressional Budget Office report showing an earlier version of the House measure would have resulted in 24 million more people without insurance within a decade.
That wing is led by Sen. Bill Cassidy of Louisiana, a doctor who worked for decades in a charity hospital, and Collins. Together they crafted a more moderate plan that kept the Affordable Care Act's taxes in place instead of repealing them.
Other senators who have expressed concerns about the House bill include Tom Cotton of Arkansas and Cory Gardner of Colorado, who both hail from states that have benefited from the health law's Medicaid expansion. The House measure included an $800 billion-plus cut to Medicaid.
"I don't support the House bill as currently constructed," Ohio's Portman said. "I continue to have concerns that this bill does not do enough to protect Ohio's Medicaid expansion population."
The Medicaid cut also led Sen. Shelley Moore Capito of West Virginia, Portman and Murkowski to object to the House bill. .
It's unclear whether senators who object to the Medicaid cut would be satisfied by reallocating some of the spending, shrinking the tax cuts, or some combination. Senators have been meeting in small groups and discussing possible amendments.
On the party's right flank, Cruz and Rand Paul of Kentucky will try to pull any measure closer to a full repeal of the Affordable Care Act while adding conservative planks. It's not clear how they can do so and still get enough votes to pass the final product.
Cruz said Wednesday that he is talking with senators and the administration about ways to improve the bill and bring down premiums. One provision he hopes to add is an amendment allowing insurers to sell coverage across state lines to boost competition. That's something Trump promised during the campaign, but it could run into procedural objections and political resistance.
Paul, meanwhile, may be the toughest vote to get on the right. The libertarian-minded senator has criticized the House bill for continuing some tax-credit payments to insurance companies.
Protests Back Home
Meanwhile, House Republicans returning home to their districts faced protesters.
Constituents gathered outside the offices of Reps. Patrick Tiberi and Rep. Fred Upton in Ohio and Michigan.
Majority Whip Kevin McCarthy of California and Reps. David Valadao of California, Billy Long of Missouri, David McKinley in West Virginia and Bruce Poliquin of Maine were among other members targeted by frustrated constituents. In Texas, anti-Trump activists planned to demonstrate on the state's Capitol grounds.
Hinting at the attacks to come as next year's elections draw nearer, the Democratic House and Senate campaign committees released digital ads lambasting supporters of the legislation. The Democratic super political action committee American Bridge also released a digital ad that urged: "Tell Senate Republicans this is their mess now, and we are watching."
The legislation could become a major issue for vulnerable House Republicans in divided districts, and House Minority Leader Nancy Pelosi, D-Calif., has already warned that they will "glow in the dark" over their vote.
Using the "IAmAPreexistingCondition" hashtag Friday, Twitter users including actress Alyssa Milano described how the proposed House law could affect them or family members dealing with serious illnesses. Some describe suffering from cancer, hereditary diseases or post-traumatic stress disorder brought on by combat.
On the other side, a GOP group allied with the House leadership announced plans to run TV ads thanking Republicans who voted for the repeal bill in key districts.
Health associations, which were largely dismayed by the GOP health care legislation, were turning their attention to Senate Republicans.
"We urge the Senate to promptly put aside the AHCA, and instead work with our organizations to achieve real bipartisan solutions to improve affordability, access, and coverage for all," said a statement released jointly by six groups including the American Academy of Family Physicians, the American Academy of Pediatrics and the American College of Physicians. It used an acronym to refer to the House measure, the American Health Care Act.
Andrew Gurman, president of the American Medical Association, said the GOP bill would result in millions of people losing coverage but said "action is needed ... to improve the current health care insurance system."
Health insurers were pleased the GOP health care bill would repeal the law's taxes but said they dislike other parts, such as how it would reduce the insurance subsidies available to people without employer-sponsored coverage.
"We stand ready to work with members of the Senate and all policymakers, offering our recommendations for how this bill can be improved to ensure the private market delivers affordable coverage for all Americans," America's Health Insurance Plans President Marilyn Tavenner said in a statement.
Separately Friday, Sarah Huckabee Sanders cautioned against reading too much into the president's Thursday night comment in which he praised Australia's government-funded health care system, describing the U.S. health system as failing.
Republicans have strongly opposed calls to create a similar "universal" health care system in the U.S.
Sanders said he was complimenting a foreign leader on the "operations of their health care system" and that he "didn't mean anything more than that." Trump's comment came as he met with Australian Prime Minister Malcolm Turnbull.
Still, Trump tweeted Friday morning, "Of course the Australians have better healthcare than we do -- everybody does. ObamaCare is dead! But our healthcare will soon be great."
Information for this article was contributed by Steven T. Dennis, Laura Litvan and Shannon Pettypiece of Bloomberg News; by Erica Werner, Alan Fram, Darlene Superville and Kristen Gelineau of The Associated Press; and by Paige Winfield Cunningham of The Washington Post.
A Section on 05/06/2017