WASHINGTON— Several Republican leaders on Sunday formed a political barricade around the health care bill that narrowly passed the House last week, defending how the legislation would change insurance coverage for people with preexisting illness or injury.
House Speaker Paul D. Ryan and Trump administration officials have rallied around the House legislation after intense criticism from Democrats, who say the bill would strip protections.
But moderate Senate Republicans were outright dismissive.
‘‘The House bill is not going to come before us,’’ Senator Susan Collins of Maine said on ABC’s ‘‘This Week,’’ adding that the Senate would be ‘‘starting from scratch.’’
The divergent Republican comments revealed the debate within the party about how to gut aspects of the Affordable Care Act, which became law in 2010 and which the Republican Party has promised to repeal.
A growing number of Senate Republicans are recasting President Trump’s Rose Garden celebration after the House vote as a mere starting point because of anxiety over how the House bill would affect Medicaid recipients in their states, insurance costs for people with conditions such as diabetes or cancer, or the breadth of health benefits in states that would be able to jettison federal insurance requirements.
Yet Trump and many of his allies continue to doggedly talk up the House bill, resisting the suggestion that the Senate could discard major items in the legislation, which was crafted with input from the hard-line House Freedom Caucus.
And many of them remain defiant amid the barrage of attacks from Democrats, who have insisted that the House bill would make acquiring coverage more difficult for people with serious ailments and disrupt insurance markets, and see in the Republicans’ efforts a chance to reclaim the House majority next year.
The seemingly political positioning on display Sunday underscored the fragility of the Republican Party on an issue that has galvanized them for years.
Senate Republicans, generally more centrist in their politics, do not feel compelled to herald the House bill. But House Republicans and White House advisers, who are more skittish about fraying the relationships they have cultivated with House conservatives and activists, do not want to shelve or play down the bill that just passed.
Ryan, for instance, offered a spirited defense of the House bill on ABC’s ‘‘This Week’’ as he was peppered with questions about the possibility of sharp premium increases for people with preexisting conditions and the worry that many people on Medicaid will lose their coverage. Ryan described the House bill as a ‘‘rescue operation’’ meant to address what he characterized as a badly failing Affordable Care Act.
‘‘We will want to make sure people who have bad health care status, who have a preexisting condition, get affordable coverage,’’ Ryan said. ‘‘That’s not happening in Obamacare. You got to remember, if you can’t even get a health insurance plan, what good is it? You don’t have health insurance.’’
White House chief of staff Reince Priebus acknowledged that GOP House members could face some criticism but predicted they would ultimately be ‘‘rewarded’’ by voters for having addressed what he described as the failures of the current health care law.
‘‘Sometimes in life you have to do what’s right, not what’s politically expedient,’’ Priebus said during an appearance on ‘‘Fox News Sunday.’’
With Republicans controlling both chambers in Congress and the White House, the lingering question for them is not whether to repeal some provisions of the law but whether the Senate or House will hold sway on the details.
Trump on Sunday largely remained out of public view at his secluded private golf club in Bedminster, N.J., and planned to return in the evening to Washington. He has urged the Senate to act but said little about what amendments, if any, he would support.
‘‘Republican Senators will not let the American people down! ObamaCare premiums and deductibles are way up — it was a lie and it is dead!’’ Trump tweeted Sunday.
Collins, along with fellow Republican Senators Rob Portman, of Ohio, and Lindsey Graham, of South Carolina, have in recent days spoken out forcefully against parts of the House bill, with Graham saying it ‘‘needs to be viewed with suspicion’’ and Portman asserting that ‘‘it does not meet the test of stability’’ for people who rely on the ‘‘safety net’’ of Medicaid.
Senator Roy Blunt, a Missouri Republican, said on NBC’s ‘‘Meet the Press’’ that he and his colleagues would ‘‘come up with what the Senate thinks the Senate can do.’’
Blunt said the Senate GOP will wait to review a score of the legislation’s cost from the Congressional Budget Office before moving ahead with any vote.
The House GOP did not have the final version of their bill scored last week, but it was reviewed in prior forms, with the CBO concluding that 24 million more Americans would lack health insurance by 2026 if the previous bill became law.
Priebus said concerns about people with preexisting conditions are overblown, stressing that nothing would change for people with coverage through their employer, Medicare, and Medicaid. Even people in states where governors seek waivers will be affected only if they don’t have continuous coverage, he said, and there is money in the bill to help them.
‘‘We’ve put billions . . . into high-risk pools to buy down any premiums.’’ Priebus said, referring to a change to the House bill late last week that would provide $8 billion over five years to help people with preexisting conditions afford coverage.