The Trump administration ratcheted up the pressure on Senate Republicans on Sunday to solve the policy problems in the House of Representatives' bill repealing Obamacare, urging the upper chamber to improve the bill even while defending its most controversial elements.

Senate Republicans are already eyeing major changes to the American Health Care Act, which narrowly passed the House on Thursday with no Democratic votes. The bill’s approaches to Medicaid and to insurance for people with pre-existing health conditions are among the thorny policy issues GOP leaders acknowledge the Senate must address if it hopes to repeal former President Barack Obama’s signature health legislation.


"The bill that passed out of the House is most likely not going to be the bill that is put in front of the president," Mick Mulvaney, head of the Office of Management and Budget, said Sunday.

On Saturday, White House chief of staff Reince Priebus spoke to a dozen members of a working group digging into what changes are needed to win the votes of at least 50 of the Senate’s 52 Republicans. Senate Majority Leader Mitch McConnell (R-Ky.) is part of that effort, Priebus said Sunday.

Priebus told Fox News that President Donald Trump expects the Senate to make “improvements,” which would then have to be hashed out with the House before the president could sign a bill into law. But he said he was optimistic because lawmakers face a “binary choice” between keeping Obamacare and gutting it.

“Everyone is committed to getting this thing done and getting it done as soon as possible. I don’t think everyone is going to be beating down this group of 12; I think we’re going to want to let them do their work,” Priebus said.

But the Senate is unlikely to move quickly. That working group doesn’t include two of the biggest critics of the House plan, Sens. Susan Collins of Maine and Bill Cassidy of Louisiana, who have joined a separate group of Republicans studying health care ideas, Collins said Sunday. Other members include Sens. Shelley Moore Capito of West Virginia, Johnny Isakson of Georgia and Mike Rounds of South Dakota.

Some Republicans have criticized the House bill because it phases out a recent expansion of the Medicaid program for the poor and because it would let states opt out of certain Obamacare requirements, including those aimed at maintaining affordable insurance coverage for people with pre-existing conditions.

Ohio Gov. John Kasich, who is advising Sen. Rob Portman (R-Ohio), deemed “ridiculous” the $8 billion added to the House bill for high-risk insurance pools for people with pre-existing conditions — a last-minute addition to secure more votes. On CNN on Sunday, Kasich also said slashing the Medicaid expansion would force thousands of Ohioans with mental illness to look for insurance on the individual market, likely leaving them with no coverage.

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“I hope and pray they’re going to make a much bigger bill,” Kasich said of the Senate. “I’m worried about the future, and I’m worried about people who are really vulnerable.”

Health and Human Services Secretary Tom Price insisted that the bill already addresses some of the concerns, saying it deals with people with pre-existing conditions.

“It’s absolutely true that the president is fulfilling his promise to the American people, and that is to make certain that every single American has access to the kind of coverage that they want for themselves and for their family,” Price said on “Meet the Press.”

House Speaker Paul Ryan said on ABC’s “This Week” that he also expects the Senate to boost tax credits for people ages 50 to 64, the group expected to see the largest insurance premium increases if Obamacare is repealed.

A Congressional Budget Office score issued before the most recent changes to the Republican legislation said the bill would reduce the deficit and cause premiums to eventually fall, but it would also lead to 24 million people losing insurance over a decade.

The Senate group working with McConnell met Thursday and planned to intensify its work in the coming days. Members include Portman, John Cornyn of Texas, John Thune of South Dakota, Mike Enzi of Wyoming, Orrin Hatch of Utah, Lamar Alexander of Tennessee, Tom Cotton of Arkansas, Cory Gardner of Colorado, Ted Cruz of Texas, Mike Lee of Utah, John Barrasso of Wyoming and Pat Toomey of Pennsylvania.

But the Senate is likely to be in something of a holding pattern as it awaits an updated CBO score. Senators said in interviews in recent days they were frustrated that the House decided to vote without a new estimate.

“They should have a CBO estimate. I want to know how much it costs,” said Sen. John McCain (R-Ariz.).

The White House dismissed those concerns. Mulvaney said the White House expects the bill to change so much that any score of the House bill would be essentially irrelevant. And Priebus said the administration didn’t “buy” the earlier report that estimated the bill could lead to 24 million fewer people having insurance.

“Everyone instantly isn’t going to come off insurance,” Priebus said. “That’s the old bill, that’s before the amendments were put in. And it’s also before the Senate takes the bill and makes it even better.”