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Why did the Senate, who vowed to make considerable changes to the House passed ACA (Obamacare) Replacement, not introduced their own bill from the start of the process instead of relying on the House to pass a Bill? Is it because they could not or were they unwilling to?
I am not sure if there was a process blocking this from occurring or if there were a political strategy at play.
I would guess it's because of the Origination Clause. The ACA and the AHCA are both intimately linked to taxes, which raise funds for the government and are therefore subject to the clause.
The primary reason was that a "replacement program" would have been politically impossible, and would instantly have become extremely unpopular.
During the period of Democratic control, when Obamacare was in effect, the Republicans attacked the bill mostly from the left. Their critiques were that costs were too high, that deductibles were too high, that care quality was insufficient, and that health insurance was not available to enough people.
But, now that they're in power, they been hoist by their own petard--they cannot produce a set of policies that actually provides better, lower-cost, more widely-available healthcare. Obamacare was politically easy to be against, but no replacement policy that was acceptable to conservatives could actually produce better outcomes than Obamacare did, and still allow the elimination of the new taxes that were passed with the original bill.
So the Republicans were caught between a rock and a hard place. They had built a political consensus within their party to repeal Obamacare, but had not even arrived at a set of goals and principles for a replacement policy. If you look at the original ACA bill in February, these internal Republican contradictions prevented its passage. The second, somewhat modified, replacement policy that did pass the House was sold not on its policy benefits, but on the political calculus that each Republican House member had to "take one for the team" to get some bill--any bill--passed for the good of the Party.
The repeal bill originated in the House because it is the more conservative of the two legislative bodies, and because Paul Ryan, the Speaker of the House, had a bill at the ready that could be used as a base for the new bill. It also has fewer impediments to fast passage of a bill (e.g. more polarized committees, no traditions of filibuster or unanimous consent).
Senators are not as reliant on party apparatus for their seats, and tend to be more moderate than their House colleagues because they must represent a larger constituency (an entire state, rather than a more homogeneous drawn congressional district). So, the resultant bill is more likely to look more like Obamacare than what the House produced: when the two bills are reconciled between the House and Senate, support from the House will likely drop below the majority needed to pass it.
The original ACA took months, over a year, I believe, to draft.
After years and years of claiming they wanted to repeal the ACA, but offering no alternatives or replacements, the House basically cobbled something together and tried to pass it before people could examine it and the CBO could do their fiscal analysis on it. That was held up, initially, and when the CBO scoring came out, it got an even bigger backlash than trying to shove it through, un-examined. That failed to pass.
The second version was thrown together, largely like the first, did not have any debate allowed, amendments offered, and did not, again, allow for examination of the bill by the public or CBO scoring. That time it got to a vote before the analysis was done, and barely passed.
This would indicate a bill that was hurried through without thoughtful consideration more than the Senate failing to act, or act in a timely fashion. Now that the bill has been scored by the CBO, we see that it is as much of a disaster (from a public relations standpoint) as the first version, with an estimated 23 million people to be without health insurance in ten years' time as a result of the House bill that passed, and average citizens looking to take a financial hit, especially as they get close to (but don't actually reach) Medicare eligibility. Wealthier citizens get a lot more under this measure. That generally isn't popular with the non-wealthy, which equates to many more people than those who benefit. Since the Senate does not have the luxury of claiming that the fiscal impact is not known, they're not going to take it up, as is.
The Senate, by all indications, is willing to give it a try, and is in the process of doing so. What they are unwilling to do is to rush through something as ill-considered as what passed the House.
