(Jenny Starrs/The Washington Post)

Senate Republican leaders are aiming to conclude their perilous and divisive effort to rewrite the nations health-care laws as soon as late this month, giving themselves only weeks to resolve substantial disagreements and raising the possibility that their push will collapse.

The leadership team is eyeing a vote by the end of July on a bill to be completed by early that month, with some aspiring to wrap up even sooner, as they cast ahead to the other legislative priorities on the horizon. One said he expected to hold a vote on a bill even if it lacked the support to pass, underscoring a growing desire to bring a difficult debate to a close one way or the other.

Some Senate Republican aides and associates are already privately discussing how the GOP would craft its midterm campaign message if it fails to pass a health-care bill, suggesting they could tell voters they need to build a bigger majority to finally undo the Affordable Care Act, known as Obamacare, as they have long promised.

[The Health 202: Democrats arent winning the expectations game on health care]

There is also rising pessimism among rank-and-file Republican senators about the prospect of reaching consensus on legislation to make good on a signature campaign promise, highlighting the steep climb they face to securing the 50 votes they need to pass a it.

I still think in the end theres a huge reason why we have to get to 50 on this, said Senate Republican Conference Chairman John Thune (R-S.D.) on Monday. He added: Obviously, were going to have a vote one way or the other, but if we dont pass something and we go into 18, you know, its on us to try and get this fixed.

Thune said he hoped a vote could be taken during this work period, but stressed that it would be up to Majority Leader Mitch McConnell (R-Ky.) to decide when a vote would happen. The Senates next week-long recess begins at the start of July.

Senate Republican Whip John Cornyn (R-Tex.) said, We have to get this done by the end of the July because then we need to get on to taxes in the fall. He was referring to tax-code revisions, another legislative priority Republicans have established for themselves.

Cornyn and Thune made their comments as they walked in and out of a late-afternoon meeting in McConnells office that included other key GOP senators. The Kentucky Republican and his team are expected to present rank-and-file GOP senators with several potential policy options throughout the coming week, including at a weekly luncheon on Tuesday afternoon.

A little bird told me that something like that might be rolled out, Cornyn said. But, you know, weve been talking about this for seven years. And so now is the time to start coming up with some tangible alternatives and building consensus. So, suits me.

But agreement has been very difficult for Senate Republicans to achieve amid dissent over significant policies. The biggest issues they are trying to sort out: how Medicaid should be structured and funded, whether to allow states to avoid certain Obamacare regulations and how to craft tax credits to replace existing insurance subsides.

Senate GOP leaders could present options on these fronts this week as well as on repealing taxes in the ACA, according to several senior GOP aides. Its unclear when a physical draft of the bill will be produced.

Sen. Shelley Moore Capito (R-W.Va.), who represents a state that expanded Medicaid under the ACA, said as she walked into McConnells office that she would support a slower phaseout of Medicaid expansion than was established under the health-care bill that passed the House early last month. But she added: Im not saying I support phasing it out.

Thune has been looking at ways to adjust the tax credits in the House bill to offer more assistance to elderly and lower-income Americans.

It remains unclear, however, whether hard-line conservative senators will support such proposals in a final vote.

The differing ideas reflect not only contrasts in policy but sensitivities to opposite ends of the political spectrum, with some concerned about an electoral backlash from centrist or left-leaning voters who oppose major changes to Obamacare and others worried a less aggressive assault on the ACA will leave right-leaning opponents of the law dispirited.

All the behind-the-scenes work and discussion with those parameters in mind, however, has not generated confidence in some Republican senators. Some have openly doubted that the talks are leading anywhere positive.

Sen. Lindsey O. Graham (R-S.C.) said Monday that he doesnt think Republicans will pass a health-care bill in 2017, Bloomberg News reported. Over the Memorial Day recess, Sen. Richard Burr (R-N.C.) came to the same conclusion and Sen. Jeff Flake (R-Ariz.) said he doubted a bill could pass before the August recess.

There is a growing sense among Senate Republicans that they need to either pass a health care overhaul or move on to other ways of fixing the health-care system, possibly through a tax reform bill or in smaller bipartisan legislation later this year.

Some want to move on so that Congress can focus on pressing deadlines in the late summer and early autumn, including a vote to increase the federal borrowing limit that could come as early as mid-July. Republicans have also suggested that they want to begin negotiations with Democrats on a long-term spending bill before Sept. 30 when the fiscal year ends.

The small window for action and policy disagreements has upped the chatter among Senate GOP aides and associates that making good on their often-repeated promise to undo parts of Obamacare may not be possible. Many Republicans, including top aides working on the GOP health plan, said they need to vote on health care and move on by early July, even if that means voting on a bill that fails.

Quietly, people are preparing for a lot of possible outcomes and how to deal with them, said one Republican in frequent communication with Republican senators and staff, who like other aides and allies interviewed for this story were granted anonymity to speak candidly.

Much of the serious policy work has been conducted behind the scenes by a small group of health policy staffers, with members of McConnells inner circle leading the political strategy, according to top GOP aides familiar with the negotiations. Experts have been working to craft a number of policy options that lawmakers can mix-and-match to create a final policy outline.

Senate Budget rules allow GOP leaders to scrap nearly every element of the health legislation that passed the House. The only requirement is that the Senate save $133billion, the same amount saved in the House bill.

Republicans are trying to pass a health-care bill through a procedural maneuver known as reconciliation that only requires a simple majority rather than a supermajority. But for McConnell, getting to 50 votes (Vice President Pence could break a 50-50 tie) means losing no more than two Republican senators.

Complicating matters further, leaders must also jump through a series of other procedural hoops, like waiting for an official cost estimate before the health-care bill can come up for a vote. That process typically takes around two weeks, meaning leaders would need to have a final bill in hand soon to get it scored and hold a vote by the end of next month.

Some Republican leaders sound much more like they are wishing that will happen than are counting on it.

I dont think this gets better over time, said Senate Republican Conference Vice Chairman Roy Blunt (Mo.). So my personal view is weve got, you know, about until now until the Fourth of July to decide whether the votes are there are not. And I hope they are.

Paul Kane contributed to this report.

Continued here:

Senate GOP aiming to conclude divisive health-care push one way or the other - Washington Post