Heat the oil in a large, deep skillet over medium heat. Add the sliced chicken sausage and cook, turning occasionally, until browned on all sides, 6 to 8 minutes total. Using a slotted spoon, transfer the sausage to a plate and set aside.
If the skillet seems dry, add 1 more tablespoon oil. Add the onions and red bell pepper and sauté until softened, scraping up any browned bits from the bottom of the pan, 2 to 3 minutes. Add the garlic and cook just until fragrant, about 1 minute.
Stir in the orzo and toast for 1 to 2 minutes, stirring constantly. Pour in the white wine and let it simmer until mostly reduced, about 2 minutes.
Add the marinara, chicken broth, garlic powder, paprika, Italian seasoning, crushed red pepper flakes, salt, and pepper. Stir to combine and bring to a gentle simmer (about medium-low heat). Cook uncovered, stirring occasionally, until the orzo is tender and the liquid has reduced into a thickened sauce, about 12 minutes.
Add the heavy cream (or coconut milk), spinach, Parmesan, and lemon juice and stir until the spinach wilts and the Parmesan is well combined, 1 to 2 minutes. Taste and add more salt, if desired.
Return the sausage to the skillet and stir until warmed through. Remove from the heat, finish with fresh basil, and serve warm.