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Thune, for example, is drafting a proposal that would make the tax credits more progressive. The House bill would cut off federal funds for Planned Parenthood for a year and prohibit the use of federal tax credits to buy insurance that includes coverage of abortion.

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Under the House bill, consumers could get the tax credits without going through an exchange. For several weeks, senators have been working on possible changes to the tax credits offered in the House bill to help people buy insurance. Both states have expanded Medicaid under the Affordable Care Act, providing coverage to hundreds of thousands of people.

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Toomey of Pennsylvania. Senators in both parties from states that have expanded the health care program for low-income people have expressed deep misgivings about the House bill, which essentially unravels the expansion.

13 men, and no women, are writing new g.o.p. health bill in senate

And certain issues, like efforts to reverse the expansion of Medicaid under the Affordable Care Act, are sure to receive more attention in the Senate than they got in the House. Thomas P. McConnell is likely to find the same tricky dynamic that Speaker Ryan confronted in the House: Any bill that satisfies conservatives like Mr.

Cruz and Mr. Lee risks alienating moderates like Ms. Collins and Ms. Medicaid will also vex Republican leaders in the Senate in ways it did not in the House.

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Hospital executives, among the most outspoken critics of the House bill, are in town for the annual meeting of the American Hospital Association and will lobby the Senate this week. Republicans, holding 52 seats in the Senate, can afford to lose only two members of their party on a vote to undo the health care law they have assailed for seven years. Collins, Ms. Murkowski or more junior women Republicans like Deb Fischer of Nebraska and Shelley Moore Capito of West Virginia — speaks volumes about his direction and has raised eyebrows.

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Senators are also focusing on the difficulty of administering the tax credits in the House bill, which could be used either inside or outside the public insurance marketplaces, or exchanges. Under the Affordable Care Act, the exchanges perform a vital role, determining whether consumers are eligible for premium tax credits, which, in most cases, are paid directly by the Treasury to insurance companies on their behalf.

Before his congressional career, Mr. Scott sold insurance and owned one of the most successful Allstate insurance branches in South Carolina.

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Thune, not wanting to create a new middle-class entitlement, would like to provide more financial assistance to lower-income people and less to higher-income people. Hatch of Utah, chairman of the Finance Committee, said Monday. Health Bill in Senate.

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The Internal Revenue Service has expressed concern. McConnell said Monday.

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Reince Priebus, the White House chief of staff, has said he expects the Senate to make improvements in the repeal bill that the House passed last week by a vote of to But senators have gone much further: The Senate is starting from scratch. With re-election campaigns looming, they will have their own political calculus to make. David Popp, a spokesman for Mr. McConnell, said on Monday that many Republicans were involved in devising a replacement for Mr. Popp said.

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Senator Mike Rounds, Republican of South Dakota, suggested that the Senate would spend at least two months working on the legislation. Beyond neglecting Republican women, Senate Republican leaders overlooked Senator Tim Scott of South Carolina, the only black member of their conference. The House bill would roll back the expansion of Medicaid, which has provided coverage to about 11 million people.

Savings would shrink if Congress allowed states to keep some or all of the Medicaid expansion. Collins said Monday. Together, they and their allies could hold near-veto power.

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It would also allow states to seek waivers of provisions of the Affordable Care Act that require insurers to cover maternity care. By excluding Ms. Collins and Mr. Cassidy, perhaps viewed as potential troublemakers for the bill, Senate leaders may have inadvertently created a dangerous alliance.

The group also includes three committee chairmen: Mr. Enzi of Wyoming, the head of the Budget Committee.

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The prospect of higher premiums for older Americans living in rural areas will also loom larger in a chamber where Republicans from sparsely populated states hold outsize power. But Mr. Republican senators like Susan Collins of Maine, Lisa Murkowski of Alaska and Bill Cassidy of Louisiana may prove less amenable to appeals for party unity and legislative success when the lives and health of their constituents are on the line.

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