Updated 11 p.m. ET
After seven years of promising to repeal the Affordable Care Act, Republican efforts at passing a health care bill on their own may have ended Monday night as the bill working its way through the Senate was effectively blocked. Two more GOP senators – Mike Lee of Utah and Jerry Moran of Kansas – came out in opposition to the bill, which means it cannot get enough support to pass.
Shortly afterward, President Trump wrote, "Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!"
Senate Majority Leader Mitch McConnell put out a statement promising to do just that, pointing to a 2015 bill passed by Congress and vetoed by President Obama. It would repeal the ACA with a two-year delay, giving a fixed deadline for Congress to replace the law. McConnell would still need 50 votes to bring that to the floor and it's not clear he would have those votes.
McConnell has previously said turning to Democrats to come up with fixes for the current health care system is his next step, and several senators who criticized the crafting of the current bill in private have called for such a bipartisan process.
One such senator is John McCain, R-Ariz., who was kept from returning to Washington this week due to unexpected surgery for a blood clot, requiring GOP leaders to delay their push for the overhaul bill. In a statement late Monday, McCain said, "The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation's governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care."
McCain has been among the more moderate Republicans who have joined several GOP governors in opposing the Republican health care bill's proposed cuts to Medicaid. The bill would have represented a generational restructuring of the entitlement program. The Congressional Budget Office has not yet given its estimates on the impact of the latest Senate bill, but estimates on an earlier version showed the reductions in Medicaid coverage would have meant 15 million fewer Americans would have coverage under the program in 10 years.
In addition to paralyzing the GOP on its top political pledge for the better part of a decade, stalling on the health care bill could tie up the rest of the party's agenda, including efforts at major tax reform. The health care bill has dominated work on Capitol Hill for the first six months of Trump's term, typically the most potent period for an administration to move legislation, which is also the first period in a decade when the GOP has controlled both chambers of Congress and the White House.
Before Lee and Moran, Sens. Rand Paul of Kentucky and Susan Collins of Maine had announced their opposition. With those four voting no, only 48 other Republicans in the Senate, and no support from Democrats or independents, the measure was effectively dead.
"We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs for Kansans," Moran said in a statement.
As NPR's Geoff Bennett and Tamara Keith reported earlier this week, Senate Republicans, realizing how close the tally was, had delayed taking up the measure until McCain was well enough to return to the Senate.
Geoff and Tamara wrote: "McConnell had been in a rush to get the bill to a vote, in part because it was thought more time wouldn't help and could hurt the chance for passage."
New York Sen. Charles Schumer said in a statement that the "second failure of Trumpcare is proof positive" that the bill is "unworkable."
"Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long term stability to the markets and improves our health care system," Schumer said.
"We look forward to Congress continuing to work toward a bill the president can sign to end the Obamacare nightmare and restore quality care at affordable prices," a White House spokesman said, declining to be identified by name.
AUDIE CORNISH, HOST:
The Republican health care bill in the Senate has been effectively blocked tonight. GOP Senators Mike Lee of Utah and Jerry Moran of Kansas announced they would not support it a short time ago. Without their votes, the bill cannot pass. Moran said in a statement, quote, "we must now start fresh with an open legislative process."
NPR congressional reporter Scott Detrow joins us now. Hey there, Scott.
SCOTT DETROW, BYLINE: Hey, Audie.
CORNISH: Now, this bill already had been indefinitely delayed - right? - in terms of a vote, so it had a steep climb. Help us understand what caused these Republican senators to come out tonight against it, effectively killing it.
DETROW: Well, it was interesting. The statements from Mike Lee and Jerry Moran came out at the exact same time tonight. This bill was already facing steep problems, like you said. Two Republicans had already said they were voting against it. And with John McCain out recovering, Republicans just didn't have the votes to advance it. That's why McConnell had delayed it till McCain came back.
Now you have four senators on the record saying, no, we're not going to vote for the bill. So Lee put out in his statement - this is a quote - "in addition to not repealing all of the Obamacare taxes, it doesn't go far enough in lowering premiums for middle-class families, nor does it create enough free space from the most costly Obamacare regulations." That's a lot of different concerns. And then that Moran statement, as you just said - that he said we must now start fresh with an open legislative process.
CORNISH: Right. You mentioned John McCain. He had had surgery to remove a 2-inch blood clot from above his left eye. Help us understand where this legislation goes from here.
DETROW: I think it's really unclear right now. Several more lawmakers still haven't said whether or not they support this measure. We've often seen this before. When you're waiting for the definitive, final vote to sink or pass a bill, there's a lot of hesitance. Nobody wants to be that definitive person. But once the line has been passed, you often see many more people come out and voice their concerns. That's what happened a couple of weeks ago when Mitch McConnell said he was holding the bill. Suddenly afterwards, many lawmakers came on the record and said, here are my problems.
That quote from Moran is key. Starting fresh - that does not sound like, let's get a bill to President Trump's desk in the next couple weeks. If this goes back to the beginning, if McConnell and other Republican leaders are bending to make key concessions to lawmakers like Lee and Moran, I think he can expect several other Republicans to say, well, wait a second; here are my concerns. What are you doing to fix my problems? And then that gets to the same problem this bill has had all along. It's hard to make the moderates happy and the really hardline conservatives happy since they want to do very different things here.
CORNISH: We know the White House, President Trump has been putting a lot of pressure on the Senate to pass this bill. How significant of a hit is this politically for this White House?
DETROW: I think it could be a major hit. Again, that's all - that all comes down to whether or not something gets to his desk at one point or another. I think if President Trump's able to sign a law repealing key parts of Obamacare at any point in his term, they'll be very happy with that. But this really stalled it.
Remember; Republicans wanted to do this as quickly as possible in the initial timeline that House Speaker Paul Ryan and Mitch McConnell were putting out. They thought that they would be wrapped up with this in April. Now this seems to be going back to the drawing board. That really ties up a lot of key agendas. And again, President Trump doesn't have a big legislative victory he can point to other than putting Neil Gorsuch on the bench at this point.
CORNISH: That's NPR's Scott Detrow with the news that the Senate Republican health care bill has been blocked. Two more Republicans have come out against it. Scott, thanks so much.
DETROW: Thank you. Transcript provided by NPR, Copyright NPR.