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How Senate Republicans plan to tackle health care

WASHINGTON —The fight over repealing and replacing Obamacare now turns to the Senate, where a divided GOP conference will take up the House-passed bill and work over the next several weeks to find consensus to change it so it can both meet the chamber’s unique rules and win the support of at least 51 Republicans.

Top GOP leaders say they plan an un-rushed and deliberative process to foster compromise between conservatives, who are anxious to repeal President Barack Obama’s Affordable Care Act, and moderates who dislike it too but who are worried about the policy and political ramifications of not replacing it right.

In fact, Republican leaders don’t plan to begin floor action until the Congressional Budget Office finishes formally scoring the House bill to determine its cost and impact on the uninsured. That could take at least two weeks, senators say.

“Now that the House has acted, it’s timely for the Senate to act and we have every intention of doing that,” said Sen. John Cornyn of Texas, the second-ranking Republican leader. “It’s up to us to pass a bill that 51 senators can agree on.”

What’s not clear is how much of the House bill — including its last-minute amendments dealing with coverage for people pre-existing conditions and extra funding for risk pools set up to assist them — will make it into the final Senate bill. GOP senators aren’t necessarily dissatisfied with those policies but warn they might not fit into the special demands of reconciliation, the special budget rules the Senate is employing to pass the bill because it allows them to do it with just 51 votes, not the 60 usually required for significant bills.

Sen. James Lankford, R-Oklahoma, described the House bill as “a starter piece” and a “skeleton” but said the Senate will take its time amending the bill.

“I can’t imagine it’s less than six weeks of a process for us,” Lankford said. “To just be able to go through the basics of it.”

Cornyn is a leader of a newly-formed working group of about a dozen GOP senators charged with finding compromise among members across the ideological spectrum of the conference. The members come from the finance, health, and budget committees, all which share jurisdiction on the issue.

Cornyn said Republicans don’t plan hearings to examine the issue because, “we’ve been talking about this for seven years so there’s really nothing new under the sun.”

But that frustrates some GOP senators who argue the Senate should go through “regular order” to study the issue, write and amend a bill in committee, and then debate and vote on it on the floor.

“I would encourage all of us to have a chance to participate,” said Sen. Jerry Moran, R-Kansas, who has pressed GOP leaders without success. “I am happy to have people working together to try to find a product that has broad support but in all circumstances, I think a committee process is good.”

Sen. Lindsey Graham agreed that from a “civics” standpoint it wasn’t great that the House bill had not been officially scored by the CBO nor gone through a formal amendment process but he expressed confidence the Senate will handle it right.

“I don’t care so much about the process,” he said. “The Senate is the place still in my view where you deliberate, you have a say, and you vote.”

But the biggest problem facing Senate leaders is not the process. It’s finding a way for moderate Sen. Susan Collins of Maine and conservative Sen. Rand Paul of Kentucky to vote for a final bill. Needing 51 votes to pass a bill, leaders of the 52-member GOP conference can afford few defections. (Vice President Mike Pence would break a tie 50-50 vote.)

In interviews, the senators pointed to very different concerns as the Senate takes up the issue.

“I believe the Senate will make substantial changes in the House bill and I look forward to that process,” Collins said. “There is no doubt that the ACA is flawed and that we have some individual markets that are collapsing in some states but we also have to be mindful of the ability of people to afford insurance and to have access to insurance.”

Paul said he was concerned too much taxpayer money was going to insurance companies.

“I want to vote for a repeal bill but I’m still troubled by the fact that there are hundreds of billions of dollars in this bill that will go from the Treasury — the taxpayers money — to insurance companies and I don’t like that,” he said.