House Republicans journeyed to the White House on Thursday for a health-care victory lap in the Rose Garden, but Senate Republicans were in no mood for celebration. 
 
 Instead, they sent an unmistakable message: When it comes to health care, we’re going to do our own thing. 
 
 “I think there will be essentially a Senate bill,” said Sen. Roy Blunt (R-Mo.), the chamber’s fourth-ranking Republican. 
 
 “It’s going to be a Senate bill, so we’ll look at it,” Sen. Jeff Flake (R-Ariz.) said. 
 
 “We will be working to put together a package that reflects our member’s priorities with the explicit goal of getting 51 votes,” Sen. Orrin G. Hatch (R-Utah) said. 
 
 Now that the House has narrowly passed legislation overhauling the nation’s health-care system, the measure is headed to the Senate, where Republican leaders will wrestle with political and procedural challenges complicating chances for final passage. 
 
 Republican senators are signaling that their strategy will be rooted in crafting their own replacement for the Affordable Care Act. It remains unclear how closely that measure will resemble the one that narrowly passed in the House on Thursday or whether GOP senators will resolve their stark differences. 
 
 A small group of Republican senators met Thursday morning in the office of Senate Majority Leader Mitch McConnell (R-Ky.) to begin outlining their health-care priorities, said Sen. John Cornyn (R-Tex.), McConnell’s top deputy. 
 
 “It was designed by the leader to be a smaller group of people that represent the different perspectives and points of view in our conference,” “If that group can get to ‘Yes,’ then [we will] take it to the rest of the conference,” Cornyn said. 
 
 Cornyn would not commit to a timeline for a Senate vote, simply saying, “When we get 51 senators, we’ll vote.” 
 
 Republicans hold a 52-to-48 advantage over Democrats in the upper chamber, leaving GOP leaders with a narrower margin for error than in the House, where infighting among Republican lawmakers nearly derailed the push on multiple occasions. 
 
 Signaling the frustration some Republican senators already have with the House bill, Sen. Lindsey O. Graham (S.C.) posted a skeptical note Thursday on Twitter: “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 (R-Ky.), flanked by Sen. Cory Gardner (R-Colo.), Sen. John Barrasso (R-Wyo.) and Sen. John Thune (R-S.D.), speaks to the media this week on Capitol Hill. (Aaron P. Bernstein/Getty Images) 
 
 [Republicans plan health-care vote today, capping weeks of fits and starts] 
 
 Senate Republicans have opted to use a maneuver known as reconciliation to try to pass the bill with a simple majority instead of having to clear the 60-vote threshold required for most legislation. In the current balance of power, that would require Democratic votes. Even getting to a simple majority will be no small task. 
 
 GOP senators from states that have expanded Medicaid under the Affordable Care Act, such as Sen. Rob Portman (Ohio) and Shelley Moore Capito (W.Va.), have voiced concerns about rollbacks to that program in the House bill. 
 
 “Absolutely,” replied Capito, when asked if she has still has worries. 
 
 Meanwhile, three conservative GOP senators — Ted Cruz (Tex.), Mike Lee (Utah) and Rand Paul (Ky.) — are also wild cards. 
 
 They have been willing to buck party leadership: Earlier this year, they pushed for a more aggressive repeal of the health-care law than many of their colleagues favored. 
 
 [What is in the Republican health-care bill? Your questions answered.] 
 
 “I think that the House Freedom Caucus was able to make the bill a lot less bad,” Paul said. “I think there’s still some fundamental problems that I have with it.” 
 
 Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) have already introduced an alternative plan, giving lawmakers a second measure to look at should talks over the current bill fall apart. 
 
 Then there are the procedural hoops that Senate Republicans must clear, which could steer them to strip away some of the House bill’s signature provisions. 
 
 The measure’s original version, introduced in March by House Speaker Paul D. Ryan (R-Wis.), already contained elements at risk of being struck out in the Senate under budget reconciliation rules that allow tax and spending changes but not broader policy changes. 
 
 That proposal initially left many of the ACA’s insurance regulations alone — with the goal of ensuring it would pass muster with the Senate parliamentarian, a nonpartisan officer of the Senate who decides on what may go in a reconciliation bill — but not all of them. 
 
 The version of the bill the House passed Thursday undercuts the ACA’s insurance regulations even more by giving states a path to opt out of federal requirements for insurers to cover certain “essential” health benefits — and to allow them to charge sick people the same premiums as healthy people. 
 
 The GOP bill would allow insurers to charge older Americans five times what they charge younger people, as opposed to three times as much under current law. 
 
 And it would enable insurers to increase premiums by 30 percent for people who do not remain continuously covered. ­Health policy experts, including conservative ones, have noted that the parliamentarian may decide those provisions need to be stripped out. 
 
 Additionally, members of the House voted on their bill before they received a score from the nonpartisan Congressional Budget Office, which measures how much the legislation would cost and how many people stand to lose coverage under it. Senate budget rules require a CBO score that proves the legislation will not increase the deficit after 10 years. the Senate parliamentarian can’t even start reviewing the AHCA without a score from the CBO,which is expected to take several weeks. 
 
 “I sincerely hope the Senate won’t mimic the House and try to rush it through without hearings or debate or analysis,” said Senate Minority Leader Charles E. Schumer (D-N.Y.). 
 
 The CBO projected in late March that an earlier version of the GOP health-care plan would result in 14 million more people being uninsured in 2018 than under current law. It projected the plan would slash the federal deficit by $150 billion between 2017 and 2026. 
 
 Even if Senate Republicans pass their own version of a health-care overhaul, it would have to be reconciled with the House version, creating complications. And if getting House conservatives and moderates to pass their initial measure was a challenge, it could be next to impossible to get enough of them to sign on to whatever the Senate decided to pass. 
 
 Rep. Mark Meadows (R-N.C.), chairman of the hard-right House Freedom Caucus that Paul referenced, said he will not necessarily back any changes made by the Senate. 
 
 “Obviously, the upper chamber has their own personalities and their own agendas,” Meadows said. “Certainly, it’s their agenda and not mine.” 
 
 “If they revise it, there’s no way,” Rep. Dave Brat (R-Va.), another Freedom Caucus member, said this week. Brat refused to support the Ryan bill until provisions were added for states to opt out of more insurance regulations. 
 
 “Have you been watching for the last few months how tight this is, and you’re going to shift this one or the other?” Brat said. “Good luck. You don’t have to be Einstein to game theory that one.” 
 
 Read more at PowerPost ||||| After all the energy the House just expended on ramming through its Obamacare repeal, the Senate is about to start over. 
 
 “We’re writing a Senate bill and not passing the House bill,” said Sen. Lamar Alexander (R-Tenn). “We’ll take whatever good ideas we find there that meet our goals.” 
 
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 They need to end up with a bill that can win over 50 of the 52 GOP senators in the narrowly divided chamber. And even if they accomplish that, their bill could be unpalatable to House conservatives. The House bill squeaked through on a 217-213 vote. 
 
 The two chambers have not coordinated much in recent weeks as the House — with an assist from the White House — frantically worked to kick the health care bill to the other side of the Capitol. Senate Republicans say they’ll take the time they need to understand the House bill’s ramifications. And they will insist on a score from the Congressional Budget Office before voting, unlike the House. 
 
 “Like y’all, I’m still waiting to see if it’s a boy or a girl,” said Sen. Lindsey Graham (R-S.C.). “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.” 
 
 The Senate GOP has been preparing for health care to land in its lap, but only in the most general fashion and with little input from the House. Two key House committee chairmen briefed the entire GOP caucus on the lower chamber’s plans in March, but there has been nothing equivalent since then. 
 
 “I turned the volume off some time ago and have no idea what the House is even passing,” Sen. Bob Corker (R-Tenn.) said shortly before the House vote was scheduled. 
 
 Alexander is meeting with a working group ranging in ideology from conservative Texas Sen. Ted Cruz — who led the creation of the bloc, sources said — to the more centrist Ohio Sen. Rob Portman, some of whom huddled with Senate Majority Leader Mitch McConnell (R-Ky.) on Thursday. McConnell said Thursday that the House vote was "an important step," but the Senate won't move forward on anything until the parliamentarian and CBO review the bill. 
 
 They're holding preliminary discussions of how to remake the House’s plan to gut Obamacare’s Medicaid expansion by 2020, shrink and reshape the tax credits that subsidize insurance, and allow insurers to charge more — potentially much more — to sick people than healthy people. That could effectively price people with pre-existing medical problems out of the market, which polls show is highly unpopular. 
 
 Almost all of those provisions worry many members in the more moderate upper chamber. Senate Republicans are considering stanching the coverage losses projected under the House by altering the Medicaid repeal, making tax credits more generous and strengthening protections for people with pre-existing conditions. 
 
 “There will be no artificial deadlines in the Senate. We’ll move with a sense of urgency but we won’t stop until we think we have it right.” said Alexander, who will be a leading figure in the Senate’s overhaul effort. 
 
 For instance, the Senate is likely to increase the transition period for cutting off the Medicaid expansion beyond 2020. A significant number of Senate Republicans represent states that expanded, and many have been told by their governors to fight for more Medicaid funding. 
 
 In March, Senate leaders insisted they could pass a repeal of Obamacare in a week. Now senators say the debate is likely to go into the summer, taking a month or more. Alexander would not say Thursday whether he’ll have public hearings. 
 
 Senate Majority Whip John Cornyn (R-Texas) said the Senate’s timeline for repealing the law has nothing to do with the calendar. “When we have 51 senators, we’ll vote," he said. "Not until then.” 
 
 “I would have loved to have done it yesterday,” he said. “Invariably, these things take longer than you’d like.” 
 
 If the Senate can pass a bill it is sure to be at odds with the more conservative House. And because Republicans can lose only two votes in the Senate, they must also somehow keep in line a trio of conservative senators — Mike Lee of Utah, Ted Cruz of Texas and Rand Paul of Kentucky — while also appealing to more moderate members. 
 
 “It’s close to near-impossible. Except we’ll get it done,” insisted Senate Finance Committee Chairman Orrin Hatch (R-Utah). “I’ve been at near-impossible a couple of times. And we always get it done.” 
 
 And many Republicans are worried about facing the same heat over pre-existing conditions that House Republicans are now confronting. Sen. Susan Collins (R-Maine) spoke to Maine’s insurance superintendent on Thursday to figure out how people with pre-existing conditions would be treated and said it was “very difficult to assess” because of how rushed the House process was. 
 
 “Some questions have been raised around the mechanisms for pre-existing conditions. We're going to have to look at that, a few other provisions,” said Sen. Thom Tillis of North Carolina. 
 
 Collins and Lisa Murkowski (R-Alaska), for example, both oppose the bill’s attempts to defund Planned Parenthood, while Medicaid and pre-existing conditions have emerged as other severe fault lines. Several Republicans from states that expanded Medicaid, including Murkowski, Portman and Shelley Moore Capito of West Virginia, are leery of rolling back that program. Immediately after House passage, Portman said he doesn’t support the House bill, as did Sen. Dean Heller of Nevada, the most vulnerable Republican up for reelection in 2018. 
 
 Alexander said he wants to give states more flexibility for Medicaid and “to do that in such a way as to not pull the rug out from under those who rely on the Medicaid program.” 
 
 McConnell convened a group of senators from across the Senate GOP to begin plotting out a party strategy. Senators will begin meeting frequently on Obamacare and “get into the meat of it,” said a source familiar with the meeting. 
 
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 They’ll also have to try and get buy-in from K Street. The powerful Washington health care lobbying machines had largely sat on the sidelines during the House debate, knowing the more substantial fight would be in the Senate. Now those lobby groups are ramping up, aimed at Senate Republicans. 
 
 And because Republicans are using a fast-track budget process called reconciliation to repeal Obamacare without Democratic support, the GOP must adhere to strict parliamentary rules. Democrats are vowing to bring down the bill for running afoul of those rules, though Senate Republicans can rewrite the legislation to adhere to them. That might require tossing out significant portions of the House's repeal bill, possibly including a key provision that allows states to waive coverage requirements. 
 
 “There are questions about that,” said Sen. John Thune (R-S.D.). “There may be things that they included that will have a difficult time.” 
 
 Those restrictions are what makes it impossible to fully repeal and replace Obamacare in one swoop. And conservatives, notably Cruz, are already agitating to ignore the Senate parliamentarian. 
 
 Democratic leaders are confident none of their members will help the GOP and are eager for Republicans to assume blame for the consequences of their legislation. 
 
 “I would be surprised if Senate Republicans can pull together and [pass] this. If they do, they will hold the entire bag for the huge rapid cost increase in premiums," said Sen. Patty Murray (D-Wash.). 
 
 And if Senate Republicans can deal with all these headaches, the House would have to accept the Senate’s changes or the two bodies would have to work out their disagreements. House Republicans seem to think it will get more conservative in the Senate, though they may be in for a big surprise. 
 
 “The bill will change in the Senate,” said Rep. Mark Meadows (R-N.C.), chairman of the House Freedom Caucus. "And just to be clear, I think it will get better.” ||||| WASHINGTON (Reuters) - The U.S. House of Representatives on Thursday narrowly approved a bill to repeal Obamacare, handing Republican President Donald Trump a victory that could prove short-lived as the healthcare legislation heads into a likely tough battle in the Senate. 
 
 The vote to repeal former President Barack Obama’s signature domestic achievement, which enabled 20 million more Americans to get health insurance, was Trump’s biggest legislative win since he took office in January, putting him on a path to fulfilling one of his key campaign promises as well as a seven-year quest by Republican lawmakers. 
 
 It marked a reversal of fortune for the Republican president who suffered a stunning defeat in late March when House Republican leaders pulled legislation to scrap Obamacare after they and the White House could not resolve the clashing interests of Republican moderates and the party’s most conservative lawmakers. 
 
 Trump has called Obamacare a “disaster” and congressional Republicans have long targeted the 2010 law, formally known as the Affordable Care Act, calling it government overreach. 
 
 But despite holding the White House and controlling both houses of Congress, Republicans have found overturning Obamacare politically perilous, partly because of voter fears, loudly expressed at constituents’ town-hall meetings, that many people would lose their health insurance as a result. 
 
 With Thursday’s 217-213 vote, Republicans obtained just enough support to push the legislation through the House, sending it to the Senate for consideration. No Democratic House members voted for the bill. Democrats say it would make insurance unaffordable for those who need it most and leave millions more uninsured. They accuse Republicans of seeking tax cuts for the rich, partly paid for by cutting health benefits. 
 
 The legislation, called the American Health Care Act, is by no means a sure thing in the Senate, where the Republicans hold a slender 52-48 majority in the 100-seat chamber and where only a few Republican defections could sink it. 
 
 As Republicans crossed over the vote threshold to pass the bill, Democrats in the House began singing “Na na, na na na na, hey hey hey, goodbye,” a rowdy suggestion that Republicans will lose seats in the 2018 congressional elections because of their vote. 
 
 Within an hour of the vote, Trump celebrated with House lawmakers in the White House Rose Garden. 
 
 “I went through two years of campaigning and I’m telling you, no matter where I went, people were suffering so badly with the ravages of Obamacare,” Trump said. “We are going to get this passed through the Senate. I am so confident.” 
 
 PRE-EXISTING CONDITIONS 
 
 The treatment of people with “pre-existing” conditions was one of the central issues in the House debate on the bill and is sure to resurface in the Senate. 
 
 Obamacare prevented insurers from charging those with pre-existing conditions higher rates, a common practice before its implementation. It also required them to cover 10 essential health benefits such as maternity care and prescription drugs. 
 
 The Republican bill passed on Thursday would allow states to opt out of those provisions. While insurers could not deny people insurance because of pre-existing conditions, they would be allowed to charge them as much as they want. 
 
 In an analysis released on Thursday, healthcare consultancy and research firm Avalere Health said the Republican bill would cover only 5 percent of enrollees with pre-existing conditions in the individual insurance markets. 
 
 Republicans have argued that their bill would give people more choice and reduce the role of government. 
 
 U.S. President Donald Trump (C) gathers with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, in Washington, U.S., May 4, 2017. REUTERS/Carlos Barria 
 
 In a push to pass the bill before members leave on Friday for a week in their home districts, the House voted before the bill was assessed by the non-partisan Congressional Budget Office, which estimates its cost and effect on insurance rolls. 
 
 Republicans have said the bill will be scored by the CBO and other fixes will be made before the Senate votes. 
 
 Health insurers, such as Anthem Inc, UnitedHealth Group Inc, Aetna Inc and Cigna Corp, have faced months of uncertainty over healthcare’s future. So have hospital companies, such as HCA Holdings Inc and Tenet Healthcare Corp. 
 
 CHALLENGES AHEAD 
 
 Obamacare expanded Medicaid, the government insurance program for the poor, provided income-based tax credits to help the poor buy insurance on individual insurance markets set up by the law, and required everyone to buy insurance or pay a penalty. 
 
 The Republican bill would repeal most Obamacare taxes, which paid for the law, roll back the Medicaid expansion and slash the program’s funding, repeal the penalty for not purchasing insurance and replace the law’s tax credits with flat age-based credits. 
 
 In a sign of the challenges ahead for the legislation, nearly every major medical group, including the American Medical Association and the American Hospital Association, and the AARP advocacy group for older Americans, strongly opposed the Republican bill. Many said last-minute amendments further eroded protection for the most vulnerable groups, including the sick and elderly. 
 
 “I’ve already made clear that I don’t support the House bill as currently constructed because I continue to have concerns that this bill does not do enough to protect Ohio’s Medicaid expansion population,” said Republican Senator Rob Portman. 
 
 While the bill’s fate in the Senate is uncertain, its House passage could boost Trump’s hopes of pushing through other big-ticket items on his agenda, such as tax reform. 
 
 Slideshow (12 Images) 
 
 The previous failure to overhaul healthcare legislation had raised questions about how much Republicans could work together to help Trump fulfill his campaign pledges. 
 
 “Anything that they (the Republicans) get done, that they accomplish, popular or unpopular, will show that they have the ability to make progress and to get things done and work together,” said Randy Frederick, vice president trading and derivatives at Charles Schwab in Austin, Texas. 
 
 “This puts the idea of tax reform a little bit closer to reality, simply because it’s shown that they have figured out a way to negotiate and work together,” he added. ||||| WASHINGTON — The House on Thursday narrowly approved legislation to repeal and replace major parts of the Affordable Care Act, as Republicans recovered from their earlier failures and moved a step closer to delivering on their promise to reshape American health care without mandated insurance coverage. 
 
 The vote, 217 to 213, held on President Trump’s 105th day in office, is a significant step on what could be a long legislative road. Twenty Republicans bolted from their leadership to vote no. But the win keeps alive the party’s dream of unwinding President Barack Obama’s signature domestic achievement. 
 
 The House measure faces profound uncertainty in the Senate, where a handful of Republican senators immediately rejected it, signaling that they would start work on a new version of the bill virtually from scratch. 
 
 “To the extent that the House solves problems, we might borrow ideas,” said Senator Lamar Alexander of Tennessee, chairman of the Senate health committee. “We can go to conference with the House, or they can pass our bill.” ||||| The GOP health bill likely faces an uncertain future in the Senate, but its passage by the House has immediate political impacts. WSJ's Gerald F. Seib details three key takeaways. Photo: Getty 
 
 The House Republican health bill is driven by one big idea: Insurers and markets, rather than government, should be empowered to find ways to provide health insurance to a broad set of people at affordable prices. 
 
 The bill that narrowly passed the House on Thursday creates a mechanism to free insurers to sell a wider variety of products—including less-comprehensive plans now barred by law—and to price them in new ways, potentially raising premiums for older and sicker Americans. 
 
 ...
– ObamaCare is "dead," President Trump declared after the House narrowly passed the American Health Care Act Thursday—but before he can sign the death warrant, a bigger battle looms in the Senate. Republican senators say they're going to craft their own ObamaCare replacement bill, and with the chamber divided 52-48, they're going to have to come up with something senators with views as different as Ted Cruz, Susan Collins, Rob Portman, and Rand Paul can all agree on. A roundup of coverage: Republican senators have made it clear that they plan to write their own legislation instead of rubber-stamping the House bill, and they say they're going to take as long as they need, Politico reports. "Any bill that has been posted less than 24 hours ... needs to be viewed with suspicion," said Sen. Lindsey Graham, while Sen. Bob Corker said he "turned the volume off some time ago" and has no idea "what the House is even passing." A big sticking point will be Medicaid expansion, with senators from states that expanded the program under ObamaCare fighting rollback efforts, the Hill reports. Nevada's Sen. Dean Heller and Ohio's Sen. Rob Portman are among those who've said they cannot support the House bill in its current form. The Washington Post reports that other wild cards include moderate GOP Sens. Susan Collins and Bill Cassidy, who've already introduced an alternative plan, and the conservative trio of Sens. Ted Cruz, Rand Paul, and Mike Lee, who, like the House Freedom Caucus, favor an aggressive repeal of ObamaCare. Republicans plan to get their bill through the Senate through budget reconciliation to avoid a filibuster to pass it with a simple majority, though Democrats warn that parts of the House bill violate the budget rules involved, the New York Times reports. "This bill is going nowhere fast in the United States Senate," Minority Leader Chuck Schumer said, telling Republicans they "should refuse to follow their House colleagues over a cliff, reject repeal, and work with Democrats to improve our health care system in a bipartisan way." Some analysts predict that the Senate will be ready to vote on its bill by summertime, but senators have declined to provide a timeline. "When we get 51 senators, we'll vote," said Sen. John Cornyn. Reuters reports that unlike House lawmakers, senators will be waiting for health care legislation to be scored by the Congressional Budget Office before they vote on it. The Wall Street Journal looks at how the health care system would be affected in the unlikely event that the Senate passes the House bill as is. Winners would include health insurers and high earners, while hospitals, Medicaid users, and many people with pre-existing conditions would take a hit.