The Senate’s key health care players

WASHINGTON — Competing interests among Senate Republicans could significantly complicate efforts to partially repeal and replace the 2010 health care law. But despite the influence individual members will have, two have enhanced sway among their colleagues: Orrin G. Hatch of Utah and Lamar Alexander of Tennessee.

While leadership is expected to have a heavy hand in the process, the two senior lawmakers, as chairmen of the committees of jurisdiction, will be instrumental in driving support for any measure the chamber considers. Jockeying between the two panels over authority, however, could be a detriment to any serious attempts at an overhaul of the U.S. health care system.

The legislation passed in the House is widely expected to change significantly in the Senate, and coordination between Hatch and Alexander will be critical. The two wield enormous influence over any health care legislation — Hatch as chairman of the Senate Finance Committee and Alexander as leader of the Health, Education, Labor and Pensions panel. And while members do not expect the measure to go through the formal committee process, the opinions of Hatch and Alexander carry significant weight.

“If they oppose something, it’s not going to happen, that’s the respect they command in the conference. On the other hand, if they are behind it, people will take a second look even if initially they were not sure,” Louisiana GOP Sen. Bill Cassidy said.

Part of their roles will be corralling a Republican conference that has become even more divided on the path forward on the health care law, a hurdle Alexander largely dismissed.

“There are many different views in the Senate,” he said Wednesday. “I think the most important thing is for (the House) to get it right and taking the time to get it as good a bill as possible makes it easier for us in the Senate.”

But a senior GOP lawmaker, speaking on background in order to discuss internal strategy, said the Senate was prepared to act in short order on a repeal bill if the House had passed it earlier this year _ as initially planned. The delay, the senator said, has only served to grow the opposition among factions in the Republican caucus.

Cassidy and fellow Republican Sen. Susan Collins of Maine, for example, continue to advocate their own legislation, a bill that some of their GOP colleagues would likely strongly oppose. Conservatives, such as Sens. Ted Cruz of Texas, and Mike Lee of Utah, have also been very involved in the House effort and have urged the House Freedom Caucus to push for changes that drove away some moderates in that chamber and would likely have a similar result in the Senate.

With such a thin margin — Republicans can only afford to lose two votes on the legislation to pass it under the expedited budget procedure known as reconciliation — any defections are significant. Senate Majority Leader Mitch McConnell, for his part, acknowledges the difficulty facing the chamber on health care legislation.

“We don’t want to give up on this,” the Kentucky Republican told reporters Tuesday. “When they send it over here, it’ll be a real big challenge on the Senate side as well.”

Republican aides expect McConnell to wield significant control over the initiative, partially in an attempt to avoid the drama that has plagued the House.

Among a number of actions he has taken since the start of the year, aides say McConnell has organized a working group of roughly a dozen GOP senators to discuss issues related to the repeal of the health care law. Members of the group include Hatch, Alexander, Cruz and Lee, as well as Colorado’s Cory Gardner, Arkansas’ Tom Cotton and Pennsylvania’s Patrick J. Toomey.

Toomey, when asked about the group, said meetings had just begun.

Senate Republican Policy Chairman John Barrasso of Wyoming and Senate Budget Chairman Michael B. Enzi of Wyoming, whose panel has worked closely with the House on its effort up until this point, are also expected to play a large role and both are said to serve on the working group.

But the input of Hatch and Alexander will likely be the most crucial. Legislation that eventually became the 2010 health care law advanced in the Senate the previous year largely because of the close coordination between then-Finance Chairman Max Baucus of Montana, Sen. Edward M. Kennedy of Massachusetts, then chairman of HELP, and his surrogate, Sen. Christopher J. Dodd of Connecticut. Privately, GOP aides also attribute the chaos in the House in part to the effort becoming a largely off-committee initiative, an uncommon occurrence in the Senate.

Despite the significant role they will play in the process, Hatch said he and Alexander have not engaged in any serious discussions regarding the bill’s future in the Senate.

“We’ve had some initial conversations, but not any definitive ones,” the Utah Republican said Tuesday.

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The legislation passed in the House is widely expected to change significantly in the Senate, and coordination between Orrin Hatch, pictured above, and Lamar Alexander will be critical. TNS Photo legislation passed in the House is widely expected to change significantly in the Senate, and coordination between Orrin Hatch, pictured above, and Lamar Alexander will be critical. TNS Photo

By Joe Williams

CQ-Roll Call