The House’s passage of legislation to repeal and replace ObamaCare moves the issue to the Senate, where its future is far from certain.
GOP senators have said they will overhaul the House bill, and that legislation won’t reach the floor until it has 51 votes.
Here are the five key players to watch.
Sen. Lamar Alexander (R-Tenn.)
Alexander is the chairman of the Health, Education, Labor and Pension’s Committee. He’s also in a working group created to hash out a compromise among Republicans on healthcare.
The veteran senator, who left leadership in 2011 because he wanted to focus more on policy, has been working for weeks on a reform bill that could pass the Senate on a GOP vote through special budget rules that would prevent a Democratic filibuster.
He laid out his priorities in a floor speech on Thursday.
They include helping people living in counties slated to have zero insurers on the exchanges next year; lowering premiums; “gradually” transferring to states more flexibility in the administrations of their Medicaid programs — without pulling the rug out from people who got coverage through ObamaCare’s expansion; and making sure people with pre-existing conditions have access to health insurance.
Alexander has a vetted interested in pushing reform through the upper chamber: 16 counties in his home state currently have no insurers on the exchanges for 2018.
That means people living there will have no way to use their subsidies unless Congress acts or another insurer steps in.
Sen. Susan Collins (R-Maine)
Collins, perhaps the most centrist GOP member of the Senate, says she won’t support a bill that defunds Planned Parenthood.
“I don’t think it makes sense to have the defunding of Planned Parenthood linked to this issue at all,” Collins told reporters earlier this year.
Sen. Lisa Murkowski of Maine is the other Republican who has taken this position.
Other Republicans are likely to demand that Planned Parenthood funding be cut, creating a difficult issue for GOP leaders.
Senate Majority Leader Mitch McConnell (R-Ky.) can only afford two defections on the bill, with Vice President Pence then breaking a 50-50 tie.
Collins has written her own replacement plan with Sen. Bill Cassidy (R-La.).
It would give states the option to keep ObamaCare’s subsidies, mandates and protections for people with pre-existing conditions- or opt into an alternative plan that would provide a uniform tax credit linked to a health savings account to help people afford basic, less comprehensive health insurance plans. Expect her (and Cassidy) to push for some of those changes.
Collins has also expressed concerns about the tax credits not being enough and how preexisting conditions will be handled.
Sen. Ted Cruz (Texas)
Cruz, like Paul, is a big opponent of ObamaCare and wants nothing more than to see it fully repealed.
He assembled the working group compromised of conservative and moderate members to hash out a compromise.
“We’re going to try to do it in the Senate and I hope we can get it done. My view is failure is not an option,” Cruz said in an interview with a Texas radio station this week.
“We’ve been promising the voters we’d repeal Obamacare for seven years, and I think if we fail to deliver on that I think the consequences would be catastrophic.”
Cruz has called for the Senate to repeal all of ObamaCare’s insurance regulations, which might not be allowed under the Senate’s budget rules preventing a Democratic filibuster.
It would also be a non-starter for many of his colleagues.
He’s also supported block granting Medicaid, which is an option in the House bill, as well as expanding health savings accounts and requiring continuous coverage.
Cruz was also critical of the House bill’s refundable tax credits.
Sen. Rand Paul (R-Ky)
Rand Paul hates ObamaCare, but his vote could be a tough one to pick up for McConnell.
Paul wants to get rid of all of ObamaCare’s regulations, like guaranteed coverage for people with preexisting conditions.
His dislikes the House bill’s refundable tax credits to help people buy insurance, which he calls a “subsidy by another name.”
“It’s going to take little bit of work to get me to a ‘yes’ vote,” Paul said on Fox News Thursday.
“I really want to repeal it. I just don’t want to replace it with ObamaCare lite or another federal program. The programs they put in place will be there forever,” he said, adding that “plussing it up with more federal subsidies — that’s going to make it much more difficult for me.”
It’s unlikely the Senate would pass a bill that doesn’t help people buy insurance, however.
Many senators think that credits are needed, and that the ones in the House bill aren’t enough for older and low-income individuals.
This suggests that if Paul sticks to his guns, it will be very hard to win his vote.
Which would making winning over Collins and Murkowski more critical.
Sen. Rob Portman (Ohio)
Portman is from a state that expanded Medicaid, and his governor, John Kasich, is an ardent supporter of the expansion.
“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” they wrote.
The House bill would freeze the expansion in 2020.
Portman told The Hill this week he’d like to see a “longer runway” for reforming Medicaid instead of abruptly capping the program two years from now.
In Portman’s state, at least 700,000 people gained coverage through the expansion.