It was a grim week for the Republican effort to repeal Obamacare.
The few GOP senators who hosted town hall meetings over the July Fourth recess were hammered by constituents for trying to undo the health care law. Reliable conservatives like Sens. Jerry Moran and John Hoeven outlined their opposition to the current version of the Senate repeal bill. Even Majority Leader Mitch McConnell acknowledged at a luncheon back home in Kentucky that the effort might fail.
Buffeted by headwinds, Republicans will return to Washington on July 10 facing even longer odds for piecing together a bill that can win over skeptical moderates and conservatives in the three weeks before the August recess.
The events seemed to validate McConnell’s original plan to speed a vote on a draft plan before lawmakers scattered across the country for their holiday break. Controversial legislation rarely looks more appealing after sitting out in the open for a week — conventional wisdom proved true this week. But after canceling the plan for a late June vote, the GOP may have no other option but try to wrap up repeal efforts before August.
At a Rotary Club meeting in Glasgow, Ky., McConnell opened the door a bit further to the possibility that the GOP repeal effort might fail, forcing him to turn to Democrats for a bipartisan effort to boost the health insurance markets — a warning he first issued last week after a meeting with President Donald Trump.
Implicit in those remarks was a recognition that letting Obamacare fail and blaming the fallout on Democrats — an idea Trump has floated — is not an option, particularly now that Republicans have spent more than six months debating health care.
"McConnell is now really in a position in which there are two constituencies out there: conservatives who have been told we need to repeal this and the broader rank and file who see it’s not working as well as it should," said Rodney Whitlock, vice president of health policy at ML Strategies. McConnell’s remarks "recognize the political reality that Republicans have to pick one and satisfy them."
Yet corralling 50 votes looks even more challenging after the holiday. The time away from Washington seemed to embolden uncommitted moderates, who are worried about the political and policy implications of repealing the Affordable Care Act.
“I need to have assurances that 180,000 people aren’t getting dropped off of their ability to have coverage,” Sen. Shelley Moore Capito of West Virginia told POLITICO at an energy event in her home state.
Capito has warmed to the prospect of working with Democrats to fix the ACA if the GOP’s repeal push fails. The first-term senator has particular concerns about rolling back Obamacare’s Medicaid expansion, a prospect she worries could leave thousands without coverage and hamper West Virginia’s efforts to combat the opioid epidemic.
Moran, traditionally a leadership ally, told a packed crowd of Kansans at a town hall meeting that he’s also worried about people who benefited under Obamacare losing their coverage.
“We ought to try to take care of people who were harmed by the Affordable Care Act by also providing the kind of need and care [to those] who were benefited by the Affordable Care Act — a difficult proposition," Moran told the crowd.
Hoeven, another customarily reliable vote for Republican leaders, told a North Dakota crowd that he opposes the Senate bill as written. Sen. Susan Collins, a moderate who Republican leaders have long assumed would be the hardest vote to get, said she was buoyed by the enthusiasm she saw in Maine for her opposition to the repeal effort.
At the other end of the political spectrum, conservatives drew a firm line for what they’d like to see in a bill, setting up a potentially acrimonious new round of negotiations.
Conservative groups such as FreedomWorks and Club for Growth rallied this week around an amendment backed by Sens. Mike Lee of Utah and Ted Cruz of Texas that would allow insurance companies that offer Obamacare plans to also offer plans that don’t comply with the health law’s mandates. They argue that the proposal would drive down premiums and give consumers the option of buying coverage with fewer mandates. However, insurance experts say the plan would drive up rates for sicker people.
"The challenge is we’ve got a bunch of moderate Republicans who want to keep those mandates," Cruz said on the Mark Davis radio show. "If it were up to me, I’d repeal the whole thing immediately, yesterday. But unfortunately we don’t have the votes, we don’t have 50 votes to do that, so we’re banging up against this wall."
Seung Min Kim contributed to this report from Palco, Kan., and Adam Cancryn contributed from Morgantown, W.Va.