04:51 - Source: CNN
How does WH sell health care after new CBO score?
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The dramatic quest to repeal Obamacare this spring left House Republicans politically bruised, exhausted and – perhaps most of all – relieved to finally be done.

Senate Republicans are hoping not to repeat the same experience, but nevertheless face similar obstacles, despite a determination to push forward.

They will have to bridge ideological divides among fellow senators and reach consensus on several major health care policy fronts – from what to do about Medicaid expansion to how patients with pre-existing conditions would be affected – while at the same time, selling their plan to those in the public who are disturbed by efforts to dismantle the Affordable Care Act.

President Donald Trump weighed in Wednesday morning to push senators.

“Hopefully Republican Senators, good people all, can quickly get together and pass a new (repeal & replace) HEALTHCARE bill. Add saved $’s.”

Here’s what senators can learn from the House:

Be prepared for questions – lots of them

A handful of Republican senators have formed a working group to begin hammering out a health care plan of their own. As they begin to form the outlines of a proposal, they will want to be prepared for a flood of questions from their constituents and the press when they are home this week.

Last week, a Republican House candidate in Montana put his candidacy in serious jeopardy on the eve of Election Day when a reporter from The Guardian pressed him about an unfavorable Congressional Budget Office analysis of the GOP health care bill.

Clearly exasperated by the questions, the candidate – Greg Gianforte – lashed out at the reporter and was accused of “body slamming” him. Gianforte has since been charged with misdemeanor assault. The shocking ordeal was a sharp reminder of how much difficulty some Republicans are having in defending the House’s controversial health care bill – and how important it will be for lawmakers and candidates to be prepared with appropriate responses.

Managing the Trump White House

As they craft a health care bill, senators will have the delicate task of managing what will likely be a tricky relationship with the Trump White House.

House Republicans learned first-hand just how difficult it is to work in tandem with the president and his top advisers on a task as enormous as overhauling Obamacare.

Often, it was the President himself who made things unnecessarily difficult – making promises that were not in line with the party message, demonstrating a lack of knowledge on policy details and handing out deadlines on the House conference to act swiftly, even when the votes weren’t there.

Over the weekend, Trump tweeted that Republicans should “add more dollars” to health care – a puzzling statement given that this is the opposite of what the House bill would do.

Trump weighed in with another tweet on Tuesday that again demonstrated a lack of understanding about the legislative process. “The U.S. Senate should switch to 51 votes, immediately, and get Healthcare and tax cuts approved, fast and easy. Dems would do it, no doubt!” Trump wrote on Twitter.

Republican lawmakers are using a budget reconciliation process to repeal and replace Obamacare, which already only requires 51 “yes” votes in the Senate.

Avoiding another terrible CBO headline

No other actor has created a bigger headache for Republicans than the Congressional Budget Office when it comes to their efforts to unravel Obamacare.

The non-partisan group’s most recent analysis of the health care bill that House Republicans passed had devastating headlines, primarily that the proposal would lead to 23 million fewer people having insurance by 2026. That would reverse years of historic gains in coverage under Obamacare.

Other painful findings: health care costs would rise for lower-income and sick Americans and many people would end up paying more for benefits such as maternity care, medications and mental health treatment.

If Senate Republicans are determined to get a better CBO score for their eventual bill, they will likely have to deviate significantly from the House proposal. But that, in turn, it could create another problem: that House Republicans reject the Senate bill.

01:22 - Source: CNN
CBO: 23 million more uninsured by 2026

Handling people with pre-existing conditions

Trump and Republican members have repeatedly promised that they would continue to protect people with pre-existing conditions. It’s among Obamacare’s most popular provisions, as protesters reminded lawmakers in town halls around the country.

This protection, however, is also one of the main reasons why premiums rose under Obamacare. That’s why conservative House Freedom Caucus members pushed to weaken key provisions that require insurers to provide comprehensive coverage and ban them from charging consumers based on their medical histories. These changes helped the bill garner enough votes to pass.

But they also led to one of the most damning findings in the CBO report. The agency found that the House bill could leave sicker folks unable to afford quality coverage in many parts of the country.

The Senate will now have to figure out how to lower premiums for healthier and younger Americans, while keeping insurance affordable for sicker and older consumers.

What to do about Medicaid

The future of Medicaid has split Republicans down the middle.

Moderate Republican lawmakers, along with many GOP governors, are worried that millions of their constituents would lose coverage under the House bill, which eliminates enhanced funding for Medicaid expansion and curtails federal support for the entire program. The CBO estimates that 14 million fewer people will be on the Medicaid rolls by 2026.

Many moderates want to eliminate or at least soften those provisions so that fewer are stripped of their coverage and of their access to substance abuse and mental health treatment, which has helped combat the opioid epidemic in many states.

But they are butting heads with conservatives, who see this as their chance to reform a massive entitlement program they consider to be costly and ineffective.

A select group of senators tasked with crafting a bill has had a tough time crafting a compromise between the two groups. It will continue to be one of the Senate’s trickiest balancing acts.