Senate Republicans wasted no time on Friday showing they have little use for the House bill to repeal and replace Barack Obama's Affordable Care Act amid fears among Americans that people already sick won't be able to get affordable insurance.
"At this point, there seem to be more questions than answers about its consequences," said moderate GOP Sen. Susan Collins of Maine, whose vote may prove one of the hardest to get for President Donald Trump and Majority Leader Mitch McConnell, R-Ky.
"I don't support the House bill as currently constructed," said Sen. Rob Portman, R-Ohio. "I continue to have concerns that this bill does not do enough to protect Ohio's Medicaid expansion population."
And GOP Sen. Lindsey Graham of South Carolina said over Twitter: "A bill - finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate - should be viewed with caution."
The outspoken and immediate skepticism pointed to a long road ahead in the Senate. And for a president who's already expressed disappointment in Congress' slow-moving ways, more frustration seemed assured.
"I don't think anyone in the Senate is going to be bullied into artificial benchmarks or timelines," said Josh Holmes, a GOP consultant and former chief of staff to Majority Leader Mitch McConnell. "It will be a very different process that will look very different from the one that we just saw unfolding in the House."
Senate leaders have repeatedly vowed success. "Failure is not an option," No. 2 Senate leader John Cornyn of Texas said earlier this year.
McConnell plans to move forward under special procedures that allow legislation to pass with a simple majority vote, instead of the 60 usually required for major bills in the Senate. That means he will only need Republican votes, which is all he can rely on anyway since Democrats are refusing to participate in dismantling Obama's law. But under complicated Senate rules, it also limits what can go into the legislation.
And with only a slim 52-48 majority, McConnell can lose only two senators from his sometimes fractious caucus, which runs the gamut from moderates like Collins to conservatives like Rand Paul of Kentucky and Ted Cruz of Texas. Then there are those senators who are up for re-election in 2018. Fortunately for McConnell only two are in any serious jeopardy, Dean Heller of Nevada and Jeff Flake of Arizona, but they are certain to be particularly cautious about casting their vote for anything that jeopardizes their constituents.
Hinting at the attacks to come as next year's elections draw nearer, the Democratic House and Senate campaign committees both released digital ads lambasting supporters of the legislation. Major Democratic Super PAC American Bridge also released a digital ad declaring: "Tell Senate Republicans this is their mess now, and we are watching." The legislation could become a major issue for vulnerable House Republicans in divided districts, and House Minority Leader Nancy Pelosi has already threatened they will "glow in the dark" over their vote.
At the "IAmAPreexistingCondition" hashtag on Friday, Twitter users including actress Alyssa Milano described how the proposed House law could affect them or family members dealing with serious illnesses. Some describe suffering from cancer, hereditary diseases or post-traumatic stress disorder brought on by combat.
On the other side, a GOP group allied with House leadership announced plans to run TV ads thanking Republicans who voted for the repeal bill in key districts.
The House bill, passed 217-213, would end the Obama law's fines on people who don't purchase policies and erase its taxes on health industry businesses and higher-earning people. It would dilute Obama's consumer-friendly insurance coverage requirements, like letting states permit insurers to charge higher premiums for customers with pre-existing medical conditions. The latter provision was the focus of much attention from opponents Friday.
The measure would also water down the Obamacare subsidies that help consumers afford health insurance, and it would cut Medicaid, the health insurance program for the poor and disabled, including ending extra federal payments to 31 states that expanded Medicaid to cover more people.
The provision was of particular concern to a number of Senate Republicans who represent states that expanded Medicaid, including Nevada's Heller and Arizona's Flake, who may face tough re-election challenges next year.
Senators have set up a working group of about a dozen lawmakers to examine how to craft the Senate's health bill: with members ranging from Sen. Lamar Alexander of Tennessee, who chairs the health committee, to Cornyn, Portman, Cruz and McConnell himself.