WASHINGTON — As House Republicans on Thursday shoved their health care bill across the finish line, stuffing it with amendments and extra dollars to secure a hard-won majority, the lawmakers who will inherit the legislation delivered their own message from across the Capitol:
On the Senate side, where several Republicans have long been deeply skeptical of the House effort, the bill is expected to undergo sweeping changes that might leave it unrecognizable — perhaps stripping away some of the provisions that helped earn the support of hard-right House members and ultimately secure its passage.
The Republicans’ narrow 52-member majority in the Senate leaves little room for defections, and several Republican senators have worried aloud about the House measure. Their concerns include insurance costs for poorer, older Americans and funding issues in states with high populations of hard-to-insure people.
Another chief obstacle is reconciling the reservations of Republican senators from states that expanded Medicaid under the health care law — including Sens. Rob Portman of Ohio, Lisa Murkowski of Alaska, Cory Gardner of Colorado and Shelley Moore Capito of West Virginia — whose constituents would face rollbacks under the House bill. (Aides to Portman and Capito said Thursday that their concerns remain; the offices of Murkowski and Gardner did not immediately respond to messages.)
More immediately pressing on Thursday, it seemed, was getting senators up to speed on what, exactly, the House had voted on.
“Don’t know what’s in it,” Sen. Lindsey Graham, R-S.C., said hours before the vote. “Waiting to see if it’s a boy or a girl.”
He said it appeared as if the House was “moving in a better direction,” gravitating toward state control over the health care system.
“But any bill that has been posted less than 24 hours — going to be debated three or four hours, not scored — needs to be viewed with suspicion,” he said, noting that the House vote came without an assessment from the Congressional Budget Office on the latest version’s price and impact.
Some members were less concerned.
“I’m praying for it every day,” Sen. David Perdue, R-Ga., said of the health care legislation.
In fact, a handful of wavering Republicans in the House seemed to take heart in recent days that revisions might come in the Senate.
Others have chafed at the suggestion that the upper chamber would be responsible for cleanup duty.
“They tell us they’re so smart and they’re so good at this stuff and we’re so incapable that they need to work on it — and I agree with them,” Rep. Michael C. Burgess, R-Texas, said last week. “They need to work on it. I want them to. I’m anxious to see what they’re going to do with finishing the job that we started.”
Sen. Lamar Alexander, R-Tenn., chairman of the Committee on Health, Education, Labor and Pensions, said he would “review” the House bill before proceeding.
“Then we’ll go work on the Senate bill,” he said.
One possible roadblock is the Senate parliamentarian. Republicans have pursued a procedural tool known as reconciliation in the hopes of passing the bill with a simple majority, rather than having to clear a 60-vote threshold with Democratic assistance. Reconciliation rules allow for changes on matters of taxes and spending but not broader policy changes. Some elements of the House bill had already threatened to draw the parliamentarian’s attention, and Democrats have strategized about specific components to target on these grounds.
If the threshold for passage is raised, requiring Democratic help, the minority party is unlikely to offer a lifeline.
“I hope this thing is dead on arrival, and I hope that a ton of House members lose their seat for voting for something this inhumane,” Sen. Chris Murphy, D-Conn., said.
It was up to Democrats, he said, “to tell this story and drive its approval ratings down from 18 to 8.”