House Republicans barely managed to pass their Obamacare repeal bill earlier this month, and they now face the possibility of having to vote again on their controversial health measure.

House Speaker Paul Ryan hasn't yet sent the bill to the Senate because there's a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority.

Republicans had rushed to vote on the health bill so the Senate could get a quick start on it, even before the CBO had finished analyzing a series of last-minute changes. The CBO is expected to release an updated estimate next week.

"Unaware," said Representative Jeff Denham of California, with noticeable surprise Thursday, when advised that his party leaders still hadn't sent the bill over to the Senate. Denham was one of the House Republicans who ended up voting for the measure, after earlier in the week opposing it.

"I am on the whip team and we have a lot of conversations, but we have not had that one. So I am going to look into it," said Denham, a member of the party's vote-counting team.

Downplaying Concern

One senior GOP aide downplayed any concern over the potential trouble from the CBO report, depicting it as hypothetical, and saying that leaders will cross that bridge if they need to.

According to several aides and other procedural experts, if Republicans send the bill to the Senate now and the CBO later concludes it doesn't save at least $2 billion, it would doom the bill and Republicans would have to start their repeal effort all over with a new budget resolution. Congressional rules would likely prevent Republicans from fixing the bill after it's in the Senate, the aides said.

If Republican leaders hold onto the bill until the CBO report is released, then Ryan and his team could still redo it if necessary. That would require at least one more House vote of some sort.

That vote could be cloaked in some kind of arcane procedural move, but it would still be depicted as a proxy for yet another vote on the same bill -- and reluctant Republicans will once again be forced to decide whether to back it. Only this time, they would also be saddled with the CBO's latest findings about the bill's costs and impacts.

Republicans had a sizable deficit reduction cushion -- $150 billion -- before several amendments were added to the bill at the last minute, including changes allowing states to legalize much skimpier health insurance plans.

Budget Assumptions

It's unclear what assumptions the CBO will make about what states will do with that newly created flexibility. If millions of people sign up for much cheaper, minimal insurance, that could trigger billions -- and potentially even hundreds of billions -- in costs over a decade because of the House bill's health insurance tax credits.

"We've got to wait for the CBO score," said Greg Walden of Oregon, chairman of the House Energy and Commerce Committee, which authored much of the bill. "To prove that you meet the reconciliation test."

But other senior Republicans weren't aware that leaders had been holding onto the bill.

"I had no idea," Dennis Ross of Florida, another member of the vote-counting team, said Thursday, adding that the prospect of another vote "does concern me."

GOP leaders never said publicly they were planning to hold on to the bill for two weeks or longer.

Democrats' Criticism

House Minority Whip Steny Hoyer of Maryland said Thursday that the delay is further proof that Republicans voted for this bill "before they knew what was in it."

The speaker and other Republicans urgently pushed their May 4 floor vote, despite a polarized Republican conference, using the frantic final hours to win over holdouts. Even so, 20 Republicans still voted against the bill. After the bill squeaked through, Ryan and other senior Republicans dashed to the White House for an unusual celebration of a one-chamber vote.

That 217-213 tally appeared to be a rare legislative victory for them and President Donald Trump, even if the vote was a difficult one for some rank-and-file House Republicans, who had qualms. Some have since been hit with protests in their districts and anger from constituents.

Now, two weeks later, the American Health Care Act, H.R. 1628, hasn't been transmitted from the House to the Senate, according to Senate Bill Clerk Sara Schwartzman.

"Republicans who argue that this was an open and transparent process are misleading the American people," Hoyer said. "If they have to amend the bill next week after they are informed of its effects, then they will have a very difficult time doing so given the fierce backlash over Trumpcare that we've seen in the days since passage."

Drew Hammill, a spokesman for House Minority Leader Nancy Pelosi of California, said in a statement: "As the public heat continues to rise, more and more members are getting scorched for walking the plank for a bill that has no chance of success in the Senate" or may have to be amended.

By Billy House from Bloomberg Politics, May 18, 2017

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May 19, 2017