May 5, 2017 - Health

The senators who will decide health care

Lazaro Gamio / Axios

Senate Republicans will have to mediate the same tensions between conservatives and moderates as the House did when it passed its health care legislation. Starting from scratch, it could take the Senate weeks to put their version together.

Here's how it will happen:

Majority Leader Mitch McConnell has assembled a working group of GOP members representing different factions of the caucus to discuss how to move forward. They met shortly before the House vote on Thursday, the second meeting the group has had.The bill is unlikely to go through committee, although the committee chairmen will still have an important role in the process.There will be a Congressional Budget Office score before senators take a vote. This is necessary to make sure the bill complies with Senate rules.A senior aide said there would be no deadline on passage: "Getting it right will set the date, and once the Senate Republican conference is ready to go, then it will move."

HELP Committee chairman Lamar Alexander says he'll have four priorities: help people who won't have any insurance options next year, lower premiums, give states more flexibility on Medicaid without "pulling the rug out from under people," and protecting people with pre-existing conditions.

  • Alexander on how the process will work: "We'll be informed by what the House did, and I'm sure if they worked the issues out, we'll borrow their ideas wherever we can. But we'll write a Senate bill, it'll get a [CBO] score so we'll know what the cost is, and then we'll vote."

Finance Committee chairman Orrin Hatch: "We must manage expectations and remain focused on the art of the doable."

Senators to watch:

The chairmen: Lamar Alexander, Health, Education, Labor and Pensions Committee; Orrin Hatch, Finance Committee; Mike Enzi, Budget Committee.

  • Why: They're the experts — and Enzi will be especially important since everything they do has to comply with budget "reconciliation" rules.

The Medicaid caucus: Rob Portman, Pat Toomey, Cory Gardner, Shelley Moore Capito, Lisa Murkowski, Tom Cotton and Bill Cassidy.

  • Why: These members are from states that expanded Medicaid under the Affordable Care Act, and many of them spoke out against proposed cuts in an early version of the House bill. Portman is looking into an amendment that would create a more gradual phaseout of the expansion.

The conservatives: Ted Cruz, Mike Lee and Rand Paul.

  • Why: These members — particularly Cruz and Lee — are going to be big about states' rights. And Senate Republicans can't lose more than two votes, or the bill dies.

The 2018ers: Dean Heller and Jeff Flake.

  • Why: Both are from states that expanded Medicaid and are up for reelection next year.

Leadership: Senate Republican Conference chairman John Thune and Senate Republican Policy Committee chairman John Barrasso.

  • Why: They're both heavily involved in the effort. Thune has been working on an amendment to the House bill tax credit for weeks. Barrasso, a doctor, has led the caucus's anti-Affordable Care Act messaging for years.
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