What's next for Republicans in Congress on health care reform


Now that the U.S. House has approved a health care bill and sent it on to the Senate for further action, it's not clear how swiftly GOP Senators will be able to move on that measure, or what type of different policy prescriptions might be part of plan that could be voted on in coming months by the full Senate.

Here's a look from Capitol Hill:

1. What kind of plan will GOP Senators develop? It wasn't clear that the House would actually pass anything, so development of a Senate GOP health plan has not been on the front burner of late. Two main committees will be in play, the Finance Committee chaired by Sen. Orrin Hatch of Utah, and the Health, Education, Labor and Pensions panel chaired by Sen. Lamar Alexander of Tennessee. Minutes after the House vote on Thursday, Alexander went to the Senate floor and set out four goals for any health bill: 1) help those who are in counties where there are few or zero insurance options in the Obamacare exchanges; 2) lower premium rates; 3) give states more flexibility on Medicaid; and 4) ensure that people with pre-existing conditions have health coverage. Republicans have set up a working group to try to formulate a plan - 13 Senators out of 52 Republicans - that's one of every four.

2. Will Democrats play any role in forging a bill? This is an important question to be asked and answered. Think of it this way, if Republicans are so divided that they cannot pass a health care bill, then the GOP plan would run aground. (Some Democrats might prefer that type of outcome.) So far, Senate Democrats indicate that the GOP has not reached out to ask for cooperation on writing a bill. But what happens if the GOP can't get to 50 votes in the Senate on a plan of their own? Should Democrats agree to make some changes in the Obama health law, which is clearly not operating on all cylinders right now? Some Democratic strategists are sending their own message:

3. The Senate rules will play an important role. The rules on the 'budget reconciliation' process are a bit more tricky for the GOP in the Senate, than in the House. Remember, only a small portion of the Obama health law was approved under reconciliation, where no Senate filibuster is allowed. If you want to really rip out the roots of that law, you would need 60 votes in the Senate to do that, and Republicans don't have that kind of support. It's important to note that not everything in the House bill is expected to pass parliamentary muster in the Senate, as there are questions about some of the changes dealing with pre-existing conditions, essential health benefits and more. The rulings of the Senate Parliamentarian will be very important here.

4. There will be pressure from President Trump for action. For months, Senators wondered if the House would produce any bill, raising the possibility that health care overhaul would go nowhere. But now, as the headline accurately said in the Washington Post, the Senate has the hot potato when it comes to health care, as now there will be some pressure brought to bear on Republicans in the Senate to produce their own plan. "It's time to fix this broken system!" President Trump tweeted on Friday. Even if you don't like what the House approved, Mr. Trump can certainly use the bully pulpit to press Senators into action as well. "We're going to get this passed through the Senate," the President declared on Thursday from the White House Rose Garden. Stay tuned.

5. The Congressional Budget Office will weigh in soon. While the House was able to vote on a health care overhaul bill without a final review from the CBO, the rules in the Senate are more restrictive - that would not be allowed. Sometime in the next two weeks, it's expected that the CBO will issue a report on the final version of the House health bill, which should indicate that the expected savings are lower, maybe below $100 billion over ten years. "CBO will also almost certainly show that the House GOP bill spends more than the previous version," said Larry Levitt, a top official with the Kaiser Family Foundation. What the CBO states could have a big impact on the type of changes that Senate Republicans might have to consider.

House members are back in their districts this coming week - we'll see how many of them hold town hall meetings with voters - and what the reaction is to the GOP health plan.

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