WASHINGTON — As House leaders celebrated the initial passage of a repeal of the Affordable Care Act with a ride to the White House and a victorious press conference with President Trump, Republicans in the Senate had a warning: not so fast.
Despite the party’s control of both chambers of Congress, differences between representatives and senators are great, promising a long and difficult path to reconcile competing visions of a long-promised health care overhaul.
In particular, GOP moderates — whose support will be crucial to Senate passage — are expected to reject or modify many of the harshest elements of the House bill, such as allowing insurance companies to increase premiums for people with preexisting medical conditions.
No senator of either party has offered a public, full-throated endorsement of the provisions in the Republicans’ American Health Care Act in its current form, and the Senate is beginning to write its own version of the bill from the ground up. While it’s often frustrating to those who demand rapid change (such as the newly elected president), it’s not an uncommon role for the Senate, playing sea anchor for American democracy, using its more deliberative process and cumbersome rules to protect, at least, against hasty actions.
“The bill, as it passed in the House, is dead on arrival in the Senate,’’ said Senator Ed Markey, a Massachusetts Democrat.
Republican leaders are expected to use the procedural process called budget reconciliation to lower the vote threshold in the Senate from 60 votes, which would be required to break a Democratic filibuster, to a simple majority of 51 votes. That means they can pass a bill without any Democrats, but with just two GOP votes to spare. Moreover, only matters relating to the budget can be passed using reconciliation, so the provision that would allow states to eliminate guarantees for coverage of preexisting conditions could be subject to parliamentary challenge — and the higher, 60-vote threshold.
Trump and House leaders, desperate to secure a signature political victory, will have to court conservative hard-liners such as Senator Rand Paul of Kentucky and Senator Ted Cruz of Texas, convincing them that the AHCA goes far enough in repealing the Obamacare-era government subsidies they dislike. At the same time, they will have to appease more moderate Republican senators whose states have benefited from the Affordable Care Act’s Medicaid expansion, such as Shelley Moore Capito of West Virginia and Rob Portman of Ohio.
Portman and Senator Dean Heller, a Republican from Nevada who is up for a contentious reelection in 2018, reiterated Wednesday that they remain opposed to the House bill in its current form. Senator Tom Cotton, a conservative from Arkansas, has previously criticized his Republican colleagues for passing a bill under a governmental cloak of secrecy.
Republican Senator Lindsey Graham of South Carolina tweeted Wednesday that “a bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution.’’
Senate majority leader Mitch McConnell, a Kentucky Republican, tasked with bringing the Republicans to a consensus, conceded that the caucus has a long way until it reaches that goal.
“When they send it over here, it’ll be a real big challenge on the Senate side as well, and you’ll have an opportunity to file lots of stories about the discussions as we move toward trying to achieve that,’’ McConnell told reporters this week.
Democrats are gearing up for the fight, as are the anti-Trump advocacy groups that anchor their liberal base. Though the passage in the House edged the bill one step closer to the president’s desk, Democraticlawmakers remained confident they can muster enough opposition to kill the bill in the Senate. Senator Chuck Schumer, a New York Democrat, said the bill’s “chances for survival in the Senate are small.’’
Outside the Capitol Wednesday, Senate Democrats rallied with protesters, taking turns speaking at a podium adorned with a “Don’t Touch My Health Care’’ sign. Inside the building, several Democrats said they believed the Republicans were making a serious political miscalculation. “Mr. President, 172,000 West Virginians got insurance for the first time’’ under the Affordable Care Act, said Senator Joe Manchin of West Virginia, a Democrat who is often sympathetic with Trump’s White House.
“They voted for you, Mr. President,’’ he said. “They’re going to know who took [their insurance] away from them.’’
In an interview, Massachusetts Senator Elizabeth Warren characterized the House version of the AHCA as cruel and punitive, an act of aggression that favors the rich and hurts the poor.
“This bill will gut health care for millions of Americans. It will deliver a massive shock to one-sixth of our economy,’’ Warren said. She added a blunt prediction: “Families will go bankrupt, and people will die.’’
Senator John Cornyn of Texas, the number two Republican in the Senate, said there is no timeline for the Senate, just that they were “working toward getting 51 votes.’’
Politically, the more time the bill lingers, the more time it gives advocacy groups to pressure lawmakers.
Astead W. Herndon can be reached at astead.herndon@globe.com. Follow him on Twitter @AsteadWH
