Their Obamacare replacement faltering, Republican leaders pitched a new plan to senators Tuesday: Gut as much of the law as they can now but delay its full effect so Congress will be forced to come up with a better alternative.
The plan fell apart before lunchtime, underscoring deep rifts among Republicans and leaving the party’s seven-year pledge to scrap the Affordable Care Act in jeopardy.
Sens. Shelley Moore Capito of West Virginia, Susan M. Collins of Maine and Lisa Murkowski of Alaska said they could not support the “repeal then replace” strategy because it would inject too much uncertainty into insurance markets, which already are reeling under Obamacare.
“We can’t just hope that we will pass a replacement within the next two years,” said Ms. Collins, who was the only sitting Senate Republican to reject an identical plan in late 2015 before President Obama vetoed it.
Senate Majority Leader Mitch McConnell, Kentucky Republican, drafted — and then redrafted — an Obamacare replacement plan behind closed doors in recent weeks, yet it collapsed amid opposition from at least four Senate Republicans late Monday.
Republican leaders and President Trump couldn’t afford to lose more than two votes from their party’s 52-seat majority and still pass an Obamacare replacement plan under budget rules that freeze out Democrats, with Vice President Mike Pence serving as a tie-breaker.
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The narrow path to success clearly irked Mr. Trump, who blamed Democrats and a “few Republicans” for the embarrassing defeat.
“We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us,” he said.
Several moderate Republicans said it might be time to sit down with Democrats and develop fixes to the ailing Obamacare markets with input from governors and other stakeholders in an open process.
Republican leaders can embrace their entreaties, try to forge ahead with a partisan health care bill or shelve their repeal efforts and move onto tax reform.
Many Republicans feel they have no choice but to fulfill their repeal pledge to voters, yet their plans to accomplish that have suffered from intraparty fights and poor poll numbers.
Meanwhile, activists have voiced loud opposition to Republican attempts to rein in two health care entitlements at once: subsidized coverage on the Obamacare exchanges and the Medicaid insurance for the poor.
“I don’t think we are going to move off repeal immediately, but the fact of the matter is we need to find a way to get traction among enough senators to get something accomplished,” said Sen. Tim Scott, South Carolina Republican. “We don’t seem to be there yet.”
Mr. McConnell said he will force Republicans who don’t like his latest plan — repeal Obamacare now and replace it later — to register their opposition to proceeding onto the bill on the floor early next week.
“We’ll have a vote on repealing Obamacare, essentially, the same vote that we had in 2015,” he told reporters.
“We will have demonstrated that Republicans, by themselves, are not prepared at this particular point to do a replacement,” Mr. McConnell said. “That doesn’t mean problems all go away. … My suspicion is there will be hearings about the crisis that we have, and we’ll have to see what the way forward is.”
Sen. Lamar Alexander, Tennessee Republican and chairman of the Health, Education, Labor and Pensions Committee, said Tuesday that he plans to hold hearings in the coming weeks on ways to stabilize the insurance markets.
The faltering effort reverberated on Wall Street, where forecasters are waiting to see if Mr. Trump can deliver on his key economic promises.
The Goldman Sachs Group told Bloomberg News that it still expects to see health care legislation in some form — such as a bill to stabilize the markets or a compromise that preserves some of Obamacare’s subsidy structure in exchange for state flexibility — and that stutter steps on health care shouldn’t affect Congress’ plans to pass a tax reform bill this year.
House Republicans passed an Obamacare replacement plan in May, shifting the thorny debate to the Senate. Mr. McConnell retooled the bill and planned to begin votes on it this week.
But Mr. McConnell was forced to reshuffle his agenda late Monday when Sens. Mike Lee of Utah and Jerry Moran of Kansas balked at the bill, joining Ms. Collins and Sen. Rand Paul of Kentucky, who already had objected from either end of the Republican spectrum.
Sensing an opening, House Minority Leader Nancy Pelosi, California Democrat, sent a letter to Speaker Paul D. Ryan, Wisconsin Republican, that said her troops are ready to open bipartisan talks once repeal is off the table.
“Democrats extend the hand of friendship if Republicans will set aside repeal, abandon cuts to Medicaid, and abandon huge tax breaks for the wealthy,” Mrs. Pelosi wrote.
Senate Minority Leader Charles E. Schumer, New York Democrat, extended a similar invite even as he said Mr. Trump’s cold approach to Obamacare amounted to sabotage.
“He is actively trying to undermine the health care system in the country, using millions of Americans as political pawns in a cynical game,” Mr. Schumer said.
Yet conservatives said critics were writing a premature epitaph for the repeal-and-replace effort, noting that the House struggled for weeks before it passed a plan.
“You all had four headstones for Obamacare already put up in terms of the process in the House four different times, and we managed to pass something out of the House,” said Rep. Mark Meadows, North Carolina Republican and chairman of the arch-conservative House Freedom Caucus. “We will pass something out of the Senate, it will pass through the House and it will go to the president to be signed, and I am still believing as long as we stay involved in the process we will find consensus to fix it.”
Right-leaning pressure groups said Senate Republicans should at least back the repeal bill they voted for in 2015 — the Club for Growth called it a “slam dunk” — and Mr. Trump aired his support for the approach on Twitter.
Yet policy analysts said repealing the law without a sure replacement would inject mass uncertainty into the markets.
Insurers would still be required to cover sicker Americans even if Congress immediately repealed the individual mandate requiring insurance coverage. The tax penalty serves as the law’s main incentive for getting healthier people into the marketplace, said Larry Levitt, senior vice president at the nonpartisan Kaiser Family Foundation.
The measure also would cut off Obamacare’s subsidies down the road, raising the stakes if Republicans failed to rally around a new form of taxpayer assistance.
“That’s a perfect recipe for a death spiral,” Mr. Levitt said, “and I don’t think insurers would stick around to watch it.”
⦁ Seth McLaughlin and S.A. Miller contributed to this report.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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