Forget the House GOP's troubles passing a health care bill. The party's bigger problem looms in the Senate.

Mitch McConnell is being tasked with fixing what GOP senators and House members say is a flawed Obamacare repeal proposal — one with little to no chance of passing in that chamber in its current form — in a week’s time.


The Senate leader and his deputies are nevertheless barreling ahead — assuming a health care bill clears the House Thursday in what’s expected to be a razor-thin vote. Senate leaders say they have a plan to jam through legislation on a party-line vote next week before opposition has time to bubble up.

And they're sticking to it, regardless of the scant level of support right now for the proposal among Senate Republicans.

As currently constructed, conservative and moderate opposition would tank the bill in the Senate, where the GOP can afford to lose only two votes. A handful of skeptical House members are voting for Speaker Paul Ryan’s plan on the assumption it will be improved in the Senate and they’ll get to make a decision when it comes back to the House. And some Republicans believe they're already losing political momentum with the health care debate and want to pull the plug.

“Maybe the best outcome is for this to fail in the House so we can move on to tax reform. Which is what we should have done anyway,” said one Republican senator, granted anonymity to make a frank assessment of the party’s political predicament.

Sen. Rand Paul of Kentucky, perhaps the most outspoken conservative critic of the House bill, had a similar view — albeit for a different reason. He wants full repeal of Obamacare, which in his view is impossible under the framework constructed by Ryan.

“I don’t think the Ryan bill will get out of the House. There are enough conservatives to stop it,” he said. “We’ll start negotiating when they stop it.”

Senate Republicans are unlikely to hold any committee hearings, and many of them haven’t even read what the House is about to pass. It’s unclear, to put it mildly, how proponents can placate enough moderates or conservatives to get the bill across the finish line.

But GOP leaders are showing no signs of applying the brakes.

“We’re not slowing down,” McConnell said on Tuesday. “We will reach a conclusion on health care next week.”

While they aren’t yet guaranteeing victory, McConnell and his deputies are moving swiftly to avoid heading into a two-week April recess with the Obamacare repeal unresolved. Letting the bill twist in the wind over that long break is viewed as a potential disaster as opposition brews back home and GOP lawmakers face antagonistic crowds at their town halls.

Instead, the Senate GOP asserts that by the first week in April there’s a good chance the Senate will have repealed and replaced Obamacare and made good on a key campaign promise from the past six years.

“The question is can we as Republicans get the health care bill out of the House and through the Senate? And I’m optimistic,” said Senate Majority Whip John Cornyn (R-Texas).

He and McConnell have not started whipping their caucus yet, but right now it’s ugly. Paul and Sens. Mike Lee of Utah and Tom Cotton of Arkansas are “no” votes. Two moderates, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, have panned recent versions of the House proposal. That’s not to mention dozens of publicly undecided members, raising concerns about everything from coverage losses to premiums increases in the short term.

The House tweaked some of those provisions just this week to get their members on board. And now some on-the-fence House Republicans say they will vote in favor so as not to derail the entire process.

“This isn’t the last vote unless you kill it,” said Rep. Tom Cole of Oklahoma,. “It’s going to the United States Senate. It will change.”

It might take a visit from President Donald Trump to get things moving in the right direction in the Senate. He's managed to flip more than a dozen House Republicans to support the legislation, which is still short of the votes it needs to pass in that chamber.

“He’s been very, very engaged. And obviously it’s a priority. He’s all in,” said Mississippi Sen. Roger Wicker, a close McConnell ally.

While the House can lose only 22 votes on Thursday, Senate Republicans have even less relative margin for error. Georgia Sen. Johnny Isakson, a reliable supporter of McConnell’s legislative priorities, is out indefinitely after two back surgeries. His office says he is trying to come back to the Senate as quickly as possible but it’s not clear whether he will return in time for the Obamacare debate.

Without Isakson, it may be impossible to pass a bill before the recess.

“We’ve got all these big votes coming up. He’ll be here as quick as he can,” said Sen. David Perdue of Georgia. “I just know Johnny well enough to know he’ll be here before his doctors even say it’s OK. He’ll be back here when we need him.”

Even with a full voting contingent, it’s hard to overstate the amount of work that McConnell is taking on in a short time. Placating conservatives and moderates simultaneously is enormously difficult. To win Paul and Lee’s vote, McConnell must pursue a more fulsome repeal, but to win over Collins and Murkowski, he must move parts of the bill to the center.

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“Alaska is a high-cost state, low population and no competition with an aging population … all of the demographic factors don’t play well with the approach the House is taken,” Murkowski said in an interview. “You’re going to have to show me that the level of support for an Alaskan in a high-cost state is going to be fair.”

Another factor: Key provisions of the bill could be stricken in the Senate because Democrats plan to argue that language restricting tax credits from being used for abortions and Medicaid work requirements are not allowed under Senate rules. That could prompt more concern from conservatives.

“We’ve looked at this backwards and forwards, and believe there is almost no chance these provisions would survive,” said a senior Democratic aide.

Still, things only get tougher for the GOP the longer the bill hangs out there. So McConnell is vowing to finish the bill next week, reckoning that such a deadline will drive consensus.

Other Republicans aren’t so sure.

“I would prefer more time,” said Louisiana Sen. Bill Cassidy, who is concerned about projections showing 24 million more people will be uninsured under Ryan’s proposal than under current law.

“I don’t think it’s going to be easy,” said Senate Finance Committee Chairman Orrin Hatch (R-Utah).

Though McConnell guarantees that Neil Gorsuch will be confirmed to the Supreme Court before the April recess, he’s a bit more circumspect when it comes to repealing Obamacare.

“We’ll either pass something that will achieve a goal that we’ve been working on," he said. "Or not.”