The Republican-controlled Senate will make one more attempt to repeal Obamacare next week, hoping to make good on a major campaign pledge made by President Donald Trump.

Trump and his Republican allies suffered a major setback when the latest effort to repeal and replace Obamacare failed in the Senate, riven by divisions between conservatives and moderates over what should come next.

The next attempt at a vote will come Tuesday. On Thursday, the White House and GOP leaders looked for ways to win over senators. It didn’t help that the Congressional Budget Office said Majority Leader Mitch McConnell’s latest bill would produce 22 million additional uninsured people by 2026 and drive up premiums for many older Americans. The budget office also said it would boost typical deductibles — the money people must pay before insurers cover costs — for single people to $13,000 that year, well above the $5,000 they’d be expected to pay under Obama’s statute.

With the fate of the health care overhaul in doubt, Trump supporters, opponents and analysts are all trying to figure out what happens next to Trump’s ambitious domestic agenda.

Trump made a fresh appeal to senators bused to the White House even as protests continued at Senate offices in the Capitol.  

“For seven years you promised the American people that you would repeal Obamacare. People are hurting. Inaction is not an option,” Trump implored at a luncheon meeting.

‘Just let Obamacare fail’

Earlier, Trump suggested it might be time to “just let Obamacare fail,” adding, “We are not going to own it.  I am not going to own it.  I can tell you the Republicans are not going to own it.”

The Republican effort next week will be focused on winning a vote on whether to have a debate on a simple repeal resolution, which Democrats strongly oppose.

“Make no mistake about it.  Passing repeal without a replacement would be a disaster,” said Senate Minority Leader Chuck Schumer, a New York Democrat.

Trump’s intensified effort to push for a health care overhaul bill comes at the six-month mark of his presidency, a tenure marked by low poll ratings and plenty of frustration that Trump has not been able to get more through Congress. “Particularly for a president who has made a lot of his campaign and his early term in office about winning, that is a real loss for him,” said Brookings Institution scholar Molly Reynolds.

Despite the latest Trump appeal and late night meetings, Senate Republicans remain divided over how to replace Obamacare.  

“There is a large majority in our conference that want to demonstrate to the American people that they intend to keep the commitment they made in four straight elections to repeal Obamacare,” said Senate Majority Leader Mitch McConnell, a Kentucky Republican.

A divided caucus

McConnell has yet to find a way to bridge the divisions between conservatives who want a more thorough repeal of Obamacare and moderates who fear the blowback from millions who could lose their health insurance coverage if the Republican replacement proposal became law.

“If they take over health care and pass something that resembles Obamacare and doesn’t work, then we will own a terrible and tragic health care system,” said Kentucky Republican Senator Rand Paul on ABC’s Good Morning America.  Paul is one of a handful of conservatives who oppose the Senate bill because it does not go far enough to roll back Obamacare.

On the other hand, moderates point to the latest Congressional Budget Office analysis of the bill that estimates 22 million people could lose their insurance coverage over the next 10 years if it became law. 

“I do not think that it is going to be constructive to repeal a law that at this point is so interwoven within our health care system,” said Senator Susan Collins, a Maine Republican.

House control at risk

The political stakes for the president and the Republicans, should they fail on health, care could be significant, since ending Obamacare was at the heart of their campaign themes for seven years.

“Ultimately I think the House [of Representatives] is certainly at risk next year for Republicans,” said University of Virginia political analyst Kyle Kondik, “particularly if the president’s approval rating stays at 40 percent or below, because historically speaking, presidents with poor approval have suffered significant losses in the House.”

If Republicans fail to resolve their differences, they may have to turn to Democrats for a compromise effort to shore up existing law.  

“If this legislation were to fail, there would be some interest in bipartisan negotiations looking at some narrower changes, particularly affecting the individual health insurance market,” said Matthew Fiedler, an expert on health care policy at the Brookings Institution.

The time spent on the lengthy health care effort has put off action on some of Trump’s other key domestic agenda items.  

“It could have been used on a tax package that has been delayed up until now,” Reynolds said.  “It could have been used on infrastructure and other legislative priorities. But instead they invested all this time on health care, and at this point they do not have anything to point to.”

Eager for a major legislative triumph and mindful of the long congressional recess scheduled for next month, Trump told senators this week “they should not leave town” unless they could agree on a health care bill.
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