Senate leadership staff will huddle this week with their colleagues on three key committees to begin drafting the chamber’s legislation to repeal and replace the 2010 health care law.

“The drafting process is going to get underway,” said John Thune of South Dakota, the third-ranking Senate Republican. “Now we have enough direction, we’ve had enough meetings, we’ve got enough input from our members to know sort of what the main issues are, and kind of where the moving points are and how we can dial things. We’ll start putting stuff together and get it out there and let people react to it.”

Senators who have joined several of the semi-weekly working group sessions led by Majority Leader Mitch McConnell of Kentucky hailed the move as the next step. The drafting efforts will include Senate staffers from the Budget Committee, the Finance Committee and the Health, Education, Labor and Pensions Committee, said Thune and Sens. Bill Cassidy of Louisiana and Ron Johnson of Wisconsin.

But the lawmakers also declined to put any artificial deadlines on the drafting process or their broader efforts to vote on a repeal and replace package. They said they are still far from an agreement.

“We’ve got enough staff to start working and come up with some base language. But there is no final agreement yet,” said Majority Whip John Cornyn of Texas. “The staff is going to put together some language we can look at when we return.”

Thune said he expected the text ultimately would be shared among all 52 Republicans in the Senate, not just those in the working group.

The Senate left Thursday on a Memorial Day recess and returns Monday, June 5. 

Guidelines

Guiding the drafting process will be the nonpartisan Congressional Budget Office score of the measure that narrowly passed the House earlier this month. That estimate, released last week, showed the package would cause 23 million people to become uninsured and would save the federal government $119 billion over a decade. The Senate version will have to save a similar amount to comply with the complex rules governing the reconciliation process that allows Republicans to sidestep the Senate’s 60-vote threshold.

That CBO score was one focus of the working group’s meeting before leaving for recess on Thursday, which was attended by Cassidy, Dan Sullivan of Alaska and Shelley Moore Capito of West Virginia, in addition to many of the original working group members. Attendees said the wide-ranging discussion also touched on Medicaid and market stabilization.

A central sticking point, after that CBO report, is the waivers that would be allowed under the House bill that will let some states opt out of certain insurance requirements like the 2010 health law’s essential health benefits. CBO suggested people with pre-existing conditions who live in those states could face much higher health insurance premiums or ultimately be priced out of coverage.

Sen. Dean Heller of Nevada suggested the CBO report “makes everything harder,” pointing to the coverage losses and those pricing issues for people with pre-existing conditions who live in states that might take waivers.

Most senators who attended the working group were noncommittal about whether a similar waiver idea would be in the Senate’s version of the legislation. Sullivan said he was outright opposed to the idea. Others, like Cassidy, said it would need to be paired with robust protections for people with pre-existing conditions.

Changes?

Sens. Ted Cruz of Texas and Thune both said there would have to be some type of flexibility in the measure.

“If we’re going to lower premiums, we have to give consumers flexibility to be able to purchase more affordable plans. We have to give states flexibility to innovate, to provide creative solutions, so those in need get better care,” Cruz said.

“There will be some authorities for states because like the House, we want to give the states as much flexibility as possible,” Thune said. “That’s what we have to try to do, to come up with options in our version that prevent those kinds of outcomes” like people being priced out of coverage.