Senate laying groundwork for own health care replacement bill

Senate Republicans left their last lunch meeting before a weeklong recess optimistic that they can at least start working on their own version of a health care bill, with something on paper to discuss when they return in June.

"I think leadership is going to spend this recess trying to develop a product," Sen. Ron Johnson, R-Wisconsin, said. "Now we'll have a base of a Senate bill based on all these discussions, based on what the House did, based on the CBO score," he continued, referring to analysis by the nonpartisan Congressional Budget Office, which measures the budgetary impact of all legislation.

While many lawmakers said there had been enough intra-conference discussions to at least launch Senate leaders and the heads of relevant committees on writing a blueprint, they also made clear there would still be plenty of wrangling among the rank-and-file before anything final emerges.

"We're negotiating. It's too early," Sen. Jeff Flake, R-Arizona, said.

The Republican-led Senate can only afford to lose two of its 52 members and still pass a health care bill. But there are diverse opinions and priorities among that group, and senators are well aware that the legislation must have almost universal appeal.

"This exercise happens to be one that involves everybody. We know that. I mean, we don't have any margin," Sen. John Thune, R-South Dakota, a member of Senate leadership, said.

He and other senators said they would be spending the Memorial Day recess reviewing the discussions that have been taking place in the Senate over the past few weeks. While all members have been invited to join the meetings, the core group includes the chairmen of the Budget, Finance, and Help, Education, Labor and Pensions (HELP) Committees, Senate leadership and a handful of other senators that have met to discuss health care long before the House passed its version of the bill on May 4.

"We've had a lot of discussions and now the timing is serious about the drafting process and that'll of course take some time," Thune said.

Sen. John Barrasso, R-Wyoming, another member of Senate leadership, said members of the conference have been meeting about five hours each week.

The upper chamber is focused, as were their House counterparts, on lowering insurance premiums as the ultimate goal, even if fewer people end up being covered because the new bill will have removed the Affordable Care Act's individual mandate.

But some Republicans object to the House plan's age-based tax credit structure, which some have argued places an undue burden on groups that can least afford it.

"Unfortunately, the CBO estimates that 23 million Americans would lose insurance coverage over the next decade, and the impact would disproportionately affect older, low-income Americans," Sen. Susan Collins, R-Maine, a moderate Republican who has been working with Sen. Bill Cassidy, R-Louisiana, on an entirely different plan, said of the House bill.

For his part, Cassidy reiterated his call for any bill to provide coverage for anyone with a life-threatening illness even if they exceed a certain amount of costs, which he called the "Jimmy Kimmel test" after the late-night talk show host revealed his newborn son's medical travails, making a plea for affordable health care for all.

The Senate bill must appease Cassidy and Collins as well as senators like Rand Paul, R-Kentucky, who object to the tax credit structure in general.

Some Republicans have also expressed concerns about the House's waiver program that would allow them to opt out of certain regulations like providing what's known as essential health benefits, required to be covered under Obamacare, and not charging people with pre-existing conditions higher premiums.

Others, especially senators who come from states that accepted the ACA's expansion of Medicaid, object to the House bill's phasing out of that expansion.

Senators have long made clear that their version will look much different from the House one, but besides getting all their members on board, they must also be mindful of what is passable in the House, which will likely have to vote on whatever final bill is hammered out between the two.

For now, the upper chamber is focused on an agreement that can satisfy 96 percent of its members (plus Vice President Mike Pence as a tiebreaker if needed).

Asked what he will say to constituents back home in Florida who might be concerned about the CBO report showing so many people could lose coverage under the House proposal, Sen. Marco Rubio said he'll make clear that the Senate is working on its own legislation, the implication being that it won't mirror the House bill.

"The Senate bill is going to be the Senate bill," he said.