Senate Republican leaders bowed to pressure from within their own ranks Tuesday and postponed a vote to overhaul the Affordable Care Act until after the Fourth of July recess, raising new doubts about their ability to fulfill one of the GOP's core promises.
The delay, which exposes lawmakers to a barrage of lobbying as they face their constituents over the holiday, has left a measure designed to pass swiftly this week teetering in the balance. Senate Majority Leader Mitch McConnell, R-Ky., had little choice after the number of Senate Republicans who said they would not support a move to bring up the bill this week rose to five after a new budget analysis of the bill.
In an effort to bring reluctant Republicans along, President Trump convened a meeting of the Senate GOP Conference in the East Room of the White House on Tuesday afternoon, where members aired grievances about what has been a secretive and contentious process. But even amid the newfound harmony, it was clear that the legislation would still need changes to secure enough votes.
"The president got an opportunity to learn all the various positions on things that we've been discussing," McConnell said after the gathering. "We all agreed that, because the markets are imploding, we need to reach an agreement among ourselves here as soon as possible and then move to the floor after the recess."
Just how realistic a vote is after July 4 remains unclear. At least one senator who had publicly opposed the procedural vote McConnell had hoped to take Tuesday - Dean Heller, Nev. - indicated that he was willing to talk about the bill again.
At the White House, Heller complained about a Trump-allied super PAC that was airing ads against him in Nevada. By Tuesday night, the group had decided to pull the ads, and Heller had signaled to McConnell that he was at the negotiating table - far from a "yes" vote, but open to discussing his concerns. Heller's willingness to deal prompted the super PAC to back down, said two Republicans familiar with the deliberations.
Nonetheless, huge hurdles remain.
Conservatives are blasting the plan for leaving in place too much of the Affordable Care Act, also known as Obamacare, while a coalition of patient advocates, doctors and senior citizens' groups have joined Democrats in decrying its proposed cuts to the Medicaid program and rollback of taxes on the wealthy.
On Tuesday, Club for Growth President David McIntosh, who has clashed with Republican Party leaders in the past, issued a statement saying the proposal "restores Obamacare."
"Only in Washington does repeal translate to restore," McIntosh said. "And while it's hard to imagine, in some ways the Senate's legislation would make our nation's failing health-care system worse."
Progressive groups began laying the groundwork to attend senators' public events, while medical providers and groups representing Americans with chronic illnesses predicted that the bill could leave millions without access to adequate medical care. The Congressional Budget Office concluded Monday that the measure would cause an estimated 22 million more Americans to be uninsured by the end of the coming decade while reducing federal spending by $321 billion.
Atul Grover, executive vice president of the Association of American Medical Colleges, told reporters that he and other doctors "take it personally" that the bill would lock people out of insurance for six months if they go for 63 days without a health plan and try to sign up for one the next year.
"We're there at the bedside," he said, adding that none of his members would be willing to tell a patient: "I'm sorry about your stage-four cancer. Come back in six months, when your insurance kicks in."
With Vice President Mike Pence ready to cast a tiebreaking vote on the measure, Republican leaders can lose only two of their 52 members to pass the bill, which no Democrat is willing to support.
At the White House, the president sat between two of the bill's holdouts - Sens. Lisa Murkowski, Alaska, and Susan Collins, Maine - and said Republicans are "getting very close" to securing the votes they need even as he acknowledged that they might fail.
"This will be great if we get it done," he said. "And if we don't get it done, it's just going to be something that we're not going to like - and that's OK. I understand that very well."
Collins described the meeting as productive, and said Trump was "really in listening mode."
She added: "He was taking in all of the comments. There were many senators who raised issues, and, as you can imagine, the issues really run the ideological gamut."
Members who publicly opposed the bill had faced a full-court lobbying press from party leaders, but they resisted it anyway. Within the past 21/2 days, Sen. Ron Johnson, Wis., has spoken with Trump, Pence, Health and Human Services Secretary Tom Price and House Speaker Paul Ryan, Wis. Sen. Rand Paul, R-Ky., spoke by phone with Trump on Monday and was scheduled to meet with him Tuesday before the vote was scuttled.
Johnson said he was "grateful" that the vote was postponed, adding that the "real deadline" would arrive when the Affordable Care Act's insurance markets collapse.
Other Republicans, such as Sen. Patrick Toomey, Pa., acknowledged that the delay could just as easily jeopardize the bill's prospects. More time, he said, "could be good and it could be bad."
Organizers at numerous "Resistance" groups, chastened by their premature celebrations after the House's repeal effort seemed to stall, said that they will use the recess to ramp up pressure on Republicans. CREDO Action, which had organized 45,000 phone calls to Senate offices, planned to increase that number when senators went home. NARAL Pro-Choice America, Planned Parenthood, MoveOn and Daily Action were organizing their own phone banks, while Indivisible groups were organizing visits - and perhaps sit-ins - at local offices.
All of that would supplement under-the-radar but attention-grabbing TV ad campaigns from AARP, Protect Our Care, and other progressive and industry groups. The goal, activists said, is to educate voters and break through to local media, which had not often covered the development of the Senate bill on front pages or in newscasts.
Senate Minority Leader Charles Schumer, D-N.Y., said that although "the fight is not over," he is confident that Republicans will not succeed because their proposals remain unpopular with the public.
"The Republican bill is rotten at the core," Schumer said. "We have a darn good chance of defeating it, a week from now, a month from now, a year from now."
Senate leaders had been working with undecided senators to determine whether any skeptics could be won over with additional spending on priorities such as expanding incentives for health-savings accounts favored by conservatives or a fund to help battle opioid addiction favored by Sens. Rob Portman, R-Ohio, and Shelley Moore Capito, R-W.Va. Leaders can add about $188 billion in new spending to the bill without running afoul of Senate budget rules.
As of Tuesday afternoon, the leaders had not earned the votes of the two members, who issued a joint statement in opposition to the proposal.
"As drafted, this bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health-care providers," Capito said.
In a sign of how pervasive opposition to McConnell's plan was, Sen. Jerry Moran, Kan., usually a reliable GOP vote, tweeted after the measure was delayed: "The Senate health care bill missed the mark for Kansans and therefore did not have my support."
Senate leaders had hoped to salvage the effort by using the CBO's estimates of deficit savings to allocate additional funding to try to ease some members' concerns.
But the release of the 49-page CBO report late Monday provided a formidable hurdle for the bill. No new senators immediately said they would back the legislation, and Johnson, Paul, Collins and Sen. Mike Lee, Utah, signaled that they would vote against starting debate on the bill in its current form. A fifth senator, Heller, had expressed his opposition last week and has not shown signs of changing his mind.
Several Republican senators said they devoted the bulk of Tuesday's meeting to questioning representatives from the CBO about their methods and estimates. Senators complained that the estimates provided in Monday's reports used old data about how many people were covered through the Affordable Care Act and how much their coverage cost. Others asked that CBO analysts start over with fresh numbers.
"They're using the March 2016 insurance market," said Sen. Roy Blunt, R-Mo. "A lot of what they do is just guessing."
According to the CBO, two-thirds of 22 million Americans who would no longer have coverage by 2027 would be low-income people who rely on Medicaid. The rest would be people who otherwise would have private insurance. Among those who buy insurance through the ACA marketplaces, analysts found, the consumers who face the largest increases in premiums would be Americans between the ages of 50 and 64.
Next year, about 15 million fewer Americans would have insurance if the Senate bill became law than under the existing law, the CBO projected.
That figure, about 1 million fewer than the House bill, would be equivalent to all the residents in 16 states - Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Rhode Island, South Dakota, Vermont, West Virginia and Wyoming - losing health coverage.
The Washington Post's Mike DeBonis, Amy Goldstein, Ed O'Keefe, Paul Kane, Elise Viebeck and David Weigel contributed to this report.