After all the energy the House just expended on ramming through its Obamacare repeal, the Senate is about to start over.

“We’re writing a Senate bill and not passing the House bill,” said Sen. Lamar Alexander (R-Tenn). “We’ll take whatever good ideas we find there that meet our goals.”


They need to end up with a bill that can win over 50 of the 52 GOP senators in the narrowly divided chamber. And even if they accomplish that, their bill could be unpalatable to House conservatives. The House bill squeaked through on a 217-213 vote.

The two chambers have not coordinated much in recent weeks as the House — with an assist from the White House — frantically worked to kick the health care bill to the other side of the Capitol. Senate Republicans say they’ll take the time they need to understand the House bill’s ramifications. And they will insist on a score from the Congressional Budget Office before voting, unlike the House.

“Like y’all, I’m still waiting to see if it’s a boy or a girl,” said Sen. Lindsey Graham (R-S.C.). “Any bill that has been posted less than 24 hours, going to be debated three or four hours, not scored? Needs to be viewed with suspicion.”

The Senate GOP has been preparing for health care to land in its lap, but only in the most general fashion and with little input from the House. Two key House committee chairmen briefed the entire GOP caucus on the lower chamber’s plans in March, but there has been nothing equivalent since then.

“I turned the volume off some time ago and have no idea what the House is even passing,” Sen. Bob Corker (R-Tenn.) said shortly before the House vote was scheduled.

Alexander is meeting with a working group ranging in ideology from conservative Texas Sen. Ted Cruz — who led the creation of the bloc, sources said — to the more centrist Ohio Sen. Rob Portman, some of whom huddled with Senate Majority Leader Mitch McConnell (R-Ky.) on Thursday. McConnell said Thursday that the House vote was "an important step," but the Senate won't move forward on anything until the parliamentarian and CBO review the bill.

They're holding preliminary discussions of how to remake the House’s plan to gut Obamacare’s Medicaid expansion by 2020, shrink and reshape the tax credits that subsidize insurance, and allow insurers to charge more — potentially much more — to sick people than healthy people. That could effectively price people with pre-existing medical problems out of the market, which polls show is highly unpopular.

Almost all of those provisions worry many members in the more moderate upper chamber. Senate Republicans are considering stanching the coverage losses projected under the House by altering the Medicaid repeal, making tax credits more generous and strengthening protections for people with pre-existing conditions.

“There will be no artificial deadlines in the Senate. We’ll move with a sense of urgency but we won’t stop until we think we have it right.” said Alexander, who will be a leading figure in the Senate’s overhaul effort.

For instance, the Senate is likely to increase the transition period for cutting off the Medicaid expansion beyond 2020. A significant number of Senate Republicans represent states that expanded, and many have been told by their governors to fight for more Medicaid funding.

In March, Senate leaders insisted they could pass a repeal of Obamacare in a week. Now senators say the debate is likely to go into the summer, taking a month or more. Alexander would not say Thursday whether he’ll have public hearings.

Senate Majority Whip John Cornyn (R-Texas) said the Senate’s timeline for repealing the law has nothing to do with the calendar. “When we have 51 senators, we’ll vote," he said. "Not until then.”

“I would have loved to have done it yesterday,” he said. “Invariably, these things take longer than you’d like.”

If the Senate can pass a bill it is sure to be at odds with the more conservative House. And because Republicans can lose only two votes in the Senate, they must also somehow keep in line a trio of conservative senators — Mike Lee of Utah, Ted Cruz of Texas and Rand Paul of Kentucky — while also appealing to more moderate members.

“It’s close to near-impossible. Except we’ll get it done,” insisted Senate Finance Committee Chairman Orrin Hatch (R-Utah). “I’ve been at near-impossible a couple of times. And we always get it done.”

And many Republicans are worried about facing the same heat over pre-existing conditions that House Republicans are now confronting. Sen. Susan Collins (R-Maine) spoke to Maine’s insurance superintendent on Thursday to figure out how people with pre-existing conditions would be treated and said it was “very difficult to assess” because of how rushed the House process was.

“Some questions have been raised around the mechanisms for pre-existing conditions. We're going to have to look at that, a few other provisions,” said Sen. Thom Tillis of North Carolina.

Collins and Lisa Murkowski (R-Alaska), for example, both oppose the bill’s attempts to defund Planned Parenthood, while Medicaid and pre-existing conditions have emerged as other severe fault lines. Several Republicans from states that expanded Medicaid, including Murkowski, Portman and Shelley Moore Capito of West Virginia, are leery of rolling back that program. Immediately after House passage, Portman said he doesn’t support the House bill, as did Sen. Dean Heller of Nevada, the most vulnerable Republican up for reelection in 2018.

Alexander said he wants to give states more flexibility for Medicaid and “to do that in such a way as to not pull the rug out from under those who rely on the Medicaid program.”

McConnell convened a group of senators from across the Senate GOP to begin plotting out a party strategy. Senators will begin meeting frequently on Obamacare and “get into the meat of it,” said a source familiar with the meeting.

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They’ll also have to try and get buy-in from K Street. The powerful Washington health care lobbying machines had largely sat on the sidelines during the House debate, knowing the more substantial fight would be in the Senate. Now those lobby groups are ramping up, aimed at Senate Republicans.

And because Republicans are using a fast-track budget process called reconciliation to repeal Obamacare without Democratic support, the GOP must adhere to strict parliamentary rules. Democrats are vowing to bring down the bill for running afoul of those rules, though Senate Republicans can rewrite the legislation to adhere to them. That might require tossing out significant portions of the House's repeal bill, possibly including a key provision that allows states to waive coverage requirements.

“There are questions about that,” said Sen. John Thune (R-S.D.). “There may be things that they included that will have a difficult time.”

Those restrictions are what makes it impossible to fully repeal and replace Obamacare in one swoop. And conservatives, notably Cruz, are already agitating to ignore the Senate parliamentarian.

Democratic leaders are confident none of their members will help the GOP and are eager for Republicans to assume blame for the consequences of their legislation.

“I would be surprised if Senate Republicans can pull together and [pass] this. If they do, they will hold the entire bag for the huge rapid cost increase in premiums," said Sen. Patty Murray (D-Wash.).

And if Senate Republicans can deal with all these headaches, the House would have to accept the Senate’s changes or the two bodies would have to work out their disagreements. House Republicans seem to think it will get more conservative in the Senate, though they may be in for a big surprise.

“The bill will change in the Senate,” said Rep. Mark Meadows (R-N.C.), chairman of the House Freedom Caucus. "And just to be clear, I think it will get better.”