House Republicans defied the odds and narrowly passed a controversial bill to repeal and replace Obamacare on Thursday afternoon, with House Speaker Paul Ryan urging his members to seize the moment and deliver on their long-held campaign promise even before members received an estimate of the bill’s effects from the Congressional Budget Office.
It took many late night meetings, last-minute amendments and old fashioned arm-twisting to push the bill through the House, but the American Health Care Act likely faces an even steeper and more treacherous climb in the staid and slow Senate.
Factions of both moderate and conservative GOP senators are deeply skeptical of the bill for entirely different reasons, making a path forward they can all agree upon difficult to imagine. The Republicans’ bare majority — just 52 votes — means they can only lose two senators and still push a repeal through. The chamber’s Democratic senators remain firmly unified against any repeal of Obamacare.
Even if Republican senators do find that path, they are unlikely to accede to House conservatives’ demands that they return the precariously negotiated legislation back to them virtually untouched. Rep. Dave Brat, R-Va., a member of the Freedom Caucus, said Tuesday the Senate better not change the AHCA “one iota,” or risk losing support. But several Republican senators said Thursday they expected to write their own, improved bill after reviewing the House version.
“When the House passes a bill, I’ll review it and then we’ll go to work on the Senate bill,” said Sen. Lamar Alexander, R-Tenn.
“The Senate will have its own bill, I don’t think this is the final product,” Sen. Bill Cassidy, R-La., said.
Several GOP senators also expressed concerns with the rushed process in the House, which voted on the revised bill less than 24 hours after posting it. Members also voted on the bill before receiving a new Congressional Budget Office estimate of its cost and effects. A previous score from the nonpartisan office estimated that 24 million people would lose insurance coverage under the original AHCA plan over 10 years. Several tweaks were made to win over support from the Freedom Caucus, the group of hardline conservative members who balked and refused to support that version of the bill.
“When they send it over here, it’ll be a real big challenge on the Senate side as well,” Senate Majority Leader Mitch McConnell, R-Ky., conceded to reporters on Tuesday.
Another potential sticking point: the AHCA cuts funds that go to Planned Parenthood, a change that both Collins and Sen. Lisa Murkowski, R-Alaska, have objected to.
It remains unclear what the Senate’s version of repeal and replace will look like. Collins, a moderate, has introduced a bill that leaves the Medicaid expansion in place but offers states a financial incentive to states not to expand. Conservative senators have balked at it, however.
When asked by a reporter Thursday if there was any bill that both she and Sens. Cruz and Paul could agree on, Collins laughed.
“You never know,” she said.