Democrats say House Republicans may have to vote again on their Obamacare repeal billbefore sending it to the Senate, citing among other things anobscure provision that affects health care for NativeAmericans.

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Republicans dismissed the problem as hypothetical, but takinganother vote is the last thing the House GOP wants to do, afterbarely managing to pass the bill on May 4 with a razor-thin 217-213margin after weeks of negotiations with dissidents in their ownparty.

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House Speaker Paul Ryan still hadn’t sent the bill to the Senateby Monday afternoon, as lawmakers await a ruling on whether themeasure is eligible for a streamlined Senate procedure allowing theGOP to pass it with a simple majority.

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The Senate parliamentarian’s decision on that question couldcome this week, possibly as soon as late Monday.

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Related: New map shows likely premium increases under AHCAby county

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Republicans and Democrats met with the Senate parliamentarianearlier in the day. Members of both parties say the latest obstaclefor the GOP involves a provision in the House bill that strikesObamacare’s cost-sharing subsidies available to help low-incomeAmericans afford their health policies, including a provisionextending them to Native Americans, according to congressionalaides.

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Democrats argue that the Native American cost-sharingeligibility issue falls under the jurisdiction of the Senate IndianAffairs Committee.

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If that’s so, the bill wouldn’t qualify for the streamlinedprocedure, which requires all policy changes to go through eitherthe Senate Health or Finance committees, said Ed Lorenzen, a senioradviser to the independent Committee for a Responsible FederalBudget.

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CBO analysis

"If the parliamentarian rules that repeal of Section 1402implicates Indian Affairs Committee jurisdiction it would be afatal violation," Lorenzen said, referring to the section of lawcontaining the cost-sharing. That would require House action "tocorrect the problem," he said.

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Related: Opposition mounts as CBO report details AHCAshortcomings

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And this time, a House vote would be taken after rank-and-fileRepublicans have seen an analysis of the bill by the CongressionalBudget Office. The nonpartisan CBO reported May 25 thatRepublicans’ revised bill would undermine insurance markets in somestates and result in 23 million more people without insurance.

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If the parliamentarian finds a significant problem, HouseRepublicans would have to decide how to fix the cost-sharingprovision. A GOP leadership aide described the change as asimple technical correction that isn’t worrisome for backers of anObamacare replacement. It could be passed by voice vote, someRepublicans contend.

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Democrats say not so fast -- they will insist on an actual floorvote.

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GOP campaign promise

The skirmishing over rules is vital in determining whetherRepublicans can meet their campaign pledge of repealing andreplacing the 2010 Affordable Care Act. Some Senate Republicansalready are voicing doubt about whether the Senate can act thisyear.

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A 13-member working group of Senate Republicans includeslawmakers with varying views, and they have yet to produce aproposal. At least four senators during last week’s Memorial Dayrecess voiced concern about whether the Senate can pass health-carelegislation: Richard Burr of North Carolina, Ben Sasse ofNebraska, Jeff Flake of Arizona and Ron Johnson of Wisconsin.

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Asked Monday if he worries that a major health care bill won’tbe passed this year, Republican Senator Lindsey Graham of SouthCarolina said, "I don’t think there will be. I just don’t think wecan put it together among ourselves."

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Republican Senator Cory Gardner of Colorado said Monday that heexpects the Senate to tackle health care before the August recess,noting that Senate leaders plan to update their Republicancolleagues on their discussions in a lunch meeting Tuesday.

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"It’s just going to be a continuation of many conversationswe’ve had, so I don’t know if tomorrow’s going to be the day whereanything is different from what we’ve seen," he told reporters."But obviously we are building up to that hopeful Augustmoment."

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The language related to Native American health care is inaddition to arguments by Senator Bernie Sanders of Vermont andothers in the Democratic caucus that the House-passed bill, H.R.1628, doesn’t meet requirements for cost savings.

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Tie-breaker vote

Democrats are working to spoil the Republican strategy ofpassing their own health-care bill with as few as 50 votes -- plusa tie-breaker from Vice President Mike Pence -- and bypassing theusual 60-vote threshold. Democrats are asking the Senateparliamentarian to rule that the House bill contains flaws thatprevent Senate Republicans from using the streamlined procedure toavoid a filibuster.

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Related: Senate GOP trying to craft ACArepeal

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To use that procedure, the measure can’t add to the deficit andthe Senate must match the House bill’s $119 billion in deficitreduction over 10 years.

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In addition, provisions overseen by the Senate Finance and theSenate Health committees must produce $1 billion in cost savingseach.

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Democrats contend the bill doesn’t meet the requirement of $1billion in cost savings under the Senate Health committee’sjurisdiction. They say that’s because funds added to the House billto stabilize state high-risk pools for the very sick push the coststoo high to meet the target, according to several Democratic aidesfamiliar with the arguments.

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