Republican healthcare bill heads to Senate, where it may undergo drastic changes

Senators caution that their version ‘would be a blank sheet of paper’ to start and signal they will pursue budget reconciliation process, which limits scope of bill

As House Republicans cheered the “beginning of the end” of the Affordable Care Act at a celebration in the White House Rose Garden on Thursday, Senate Republicans welcomed the bill with muted fanfare.

After weeks of fits and starts, House Republicans had narrowly passed a proposal to repeal and replace Obamacare and voted to forward to the Senate a bill that is both unpopular with the American public and unlikely to pass the chamber in its current form.

The Senate majority leader, Mitch McConnell, hailed the vote as “an important step” and a “job well done”. But Republicans in the upper chamber swiftly vowed to draft their own healthcare legislation rather than take up the House-passed American Health Care Act.

“We are going to draft a Senate bill,” Iowa senator Chuck Grassley told reporters on Capitol Hill. “That is what I’ve been told.”

Bill Cassidy, a senator from Louisiana who has been pushing his own Obamacare replacement plan, echoed the sentiment.

“I was given the impression it would be a blank sheet of paper,” he said, while adding of the House-passed legislation: “I’m not sure this is the last bill.”

The widespread caution among Republicans in the Senate was reflective of both the obstacles and limitations they foresee ahead. Republicans hold just 52 seats in the upper chamber and thus can afford to lose no more than two votes.

And so while House Republicans marked the moment by hopping on buses to the White House, their counterparts in the Senate warned of a long and windy road that could last anywhere from weeks to months before a vote.

“I can’t imagine less than six weeks of a process for us,” said Oklahoma senator James Lankford, while adding of the House-passed bill: “It’s a skeleton, but it’s definitely not the final product.”

The widespread consensus among Republicans was that it was difficult to truly weigh in on the House legislation due to the hurried process through which it was passed. Most Senate Republicans confessed to not knowing what was even in the House bill and declined to take an explicit position absent a score from the Congressional Budget Office.

“I’m not so sure this is good civics here – a bill [that has] not been scored, not been amended – but it is what it is,” said Senator Lindsey Graham of South Carolina.

Citing concerns with preexisting conditions and changes to Medicaid, Graham said the final drafting “will be done by the Senate”.

“The Senate is the place still, in my view, where you deliberate, you have a say, you vote,” he said.

Senate Republican leaders signaled they would pursue a process known as budget reconciliation, which would enable them pass a healthcare bill with a simple 51-majority vote. But Republicans acknowledged they were bound by rules within that process, which limit its scope to spending, taxes or the deficit.

In other words, while they would examine the provisions contained within the House-passed bill, the Senate legislation could take a very different shape.

“Anything that makes it impossible to do under reconciliation, we’ll have to either try to do it a different way or at a later time,” said Senator Roy Blunt, a member of Republican leadership.

Republican leaders said a 12-member working group would now take the reins to come up with a draft and build consensus.

The likelihood that the House language would undergo significant changes in the Senate was a selling point for a number of moderate Republicans who were wary of removing protections for individuals with preexisting conditions. Several wavering lawmakers said leadership and White House officials persuaded them by arguing that their support would get the bill over the line – and that their concerns would be resolved in the Senate.

Congressman John Faso, a New York Republican who remained publicly undecided until hours before the vote, said he resisted entreaties from leadership and the administration to discuss the bill. But he acknowledged that knowing that the proposal would be changed significantly in the Senate helped bring him on board despite having outstanding concerns with the bill.

“There’s some things I’d like to see the Senate do,” Faso told reporters. “The process moves forward from here and we’ll get another crack at this thing again.”

After Republicans failed to win enough support to bring their healthcare plan to the floor for a vote in March, moderates led by New Jersey congressman Tom MacArthur and the conservative Freedom Caucus collaborated on a compromise. An amendment drafted by MacArthur would allow states to waive rules that protect individuals with preexisting conditions from being charged more for healthcare coverage.

The provision is a likely a nonstarter in the Senate, where Republicans have already voiced concerns over maintaining coverage for preexisting conditions, among other issues. At least two Republican senators, Susan Collins of Maine and Lisa Murkowski of Alaska, have also opposed attempts to defund Planned Parenthood as part of the healthcare debate.

MacArthur remained hopeful that the Senate would not make dramatic changes.

“I think we have sent them a good bill – not a perfect bill,” MacArthur told reporters after the House vote.

“I think there are areas where they could maybe make improvements, but I think we sent them a good bill that is worthy of their consideration as is,” he added. “If they have good amendments to make, I, for one, am quite open to it.”

But MacArthur refused to speculate on whether he would support a new version of the bill if his amendment was dropped, underscoring the many unknowns that lie ahead as Republicans move forward. Even if the Senate were to advance its own plan, there is no guarantee it would not reopen the cracks in the fractious House Republican conference.

“I think it’s going one direction or another,” said Kentucky senator Rand Paul, who argued the House bill did not go far enough in repealing Obamacare’s regulations. “Either it gets better or worse, and that I can’t tell you yet.”

As Trump claimed victory, while flanked by House Republicans in what resembled a signing ceremony and not simply the opening salvo, Graham sought to tamp down expectations.

“If you know how this movie ends, you’re better off than I am.”