Congressional Republicans, their campaign to repeal and replace the Affordable Care Act in shambles, face mounting pressure to work with Democrats to make fixes to the 2010 healthcare law rather than roll it back.
But it remains unclear whether the White House and GOP leaders are prepared to reach across the aisle to stabilize insurance markets and shield Americans from rising healthcare costs, especially if that also means being seen as betraying their years-long promise to repeal Obamacare.
President Trump continued to attack Democrats after the collapse of the GOP healthcare overhaul bill Monday, followed the next morning by Senate Majority Leader Mitch McConnell’s failure to rally Republicans around a last-ditch bid to repeal most of the law without a replacement.
“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," Trump said Tuesday.
With Trump appearing increasingly isolated, however, and support evaporating for the GOP campaign against the law, Republicans in Congress may have little choice but to reset their healthcare strategy.
“Congress should go back to the drawing board and work in partnership with patient groups like the March of Dimes and other stakeholders to craft a bipartisan plan that seeks to provide affordable, quality health coverage to all Americans,” March of Dimes President Stacey D. Stewart said.
The March of Dimes was among the scores of leading patient advocates, physician groups, hospitals and others that have vehemently opposed the GOP repeal campaign.
Tuesday afternoon, Senate Health Committee Chairman Lamar Alexander (R-Tenn.) indicated he would convene hearings soon to explore ways to develop more-limited healthcare legislation.
A growing number of GOP senators — including John McCain of Arizona, who called for “input from members of both parties” — are also urging a new process that would bring in Democrats.
Polls show most Americans would support a bipartisan approach, with 71% of respondents in a recent national survey saying they want congressional Republicans to work with Democrats to make improvements to the law rather than repeal it.
By contrast, less than a quarter of the public wants Republicans to continue working on their own plan to repeal and replace the law, according to a poll by the nonprofit Kaiser family Foundation.
Congressional Democrats renewed their own calls for bipartisanship Tuesday, urging Republicans to drop their repeal campaign and work with them on fixes to the law.
“It’s time to start over,” Senate Minority Leader Charles E. Schumer (D-N.Y.) said on the Senate floor. “Rather than repeating the same failed, partisan process yet again, Republicans should work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our healthcare system.”
Such fixes wouldn’t be particularly hard, according to many insurance industry officials and state regulators.
There is widespread agreement, for example, that the federal government must continue funding assistance to low-income consumers to help offset their co-pays and deductibles, known as cost-sharing reduction payments.
Most industry and state marketplace officials also say the federal government must fund a better system to protect insurers from big losses if they are hit with very costly patients
And the Trump administration must commit to enforcing the mandate on Americans to get insurance, and aggressively market to younger, healthier consumers to get them to sign up for coverage.
“The elements of what is needed are pretty straightforward,” said Blue Shield of California Vice President Gary Cohen, who oversaw the marketplaces in the Obama administration.
Thus far, administration officials have shown little interest in taking such steps, with the president repeatedly threatening to cut off payments to low-income consumers.
Moving past the repeal campaign could allow Republicans to turn to other legislative priorities, such as overhauling the tax code, an increasingly pressing imperative for a party with a thin list of accomplishments despite having control of all branches of government.
But it is unclear what Republican lawmakers might demand and how that could complicate any bipartisan deal.
For example, eliminating the law’s insurance mandate or loosening rules on health plans — two bedrock GOP demands — could further weaken insurance markets.
Meanwhile, many GOP officials appear in no mood to compromise.
In addition to Trump’s attacks on Democrats on Tuesday, Vice President Mike Pence fired off his own criticism at lawmakers during a speech to a business group.
“Congress needs to step up. Congress needs to do their job. And Congress needs to do their job now," Pence said.
On Capitol Hill, many GOP senators were reluctant to give up on their long repeal campaign.
Sen. Ted Cruz (R-Texas), a key architect of the failed strategy, vowed to press on. “I continue to believe we can get this done,” Cruz told reporters. “We can honor our promise and repeal Obamcare.”
Others appeared to still be stunned as they struggled to make sense of what happened — and what comes next.
Many were blindsided late Monday when Republican Sens. Mike Lee of Utah and Jerry Moran of Kansas jointly announced they would oppose McConnell’s bid to advance legislation repealing and replacing major parts of the law.
That was followed Tuesday morning by a quick revolt among three female Republican senators against McConnell’s backup plan to bring up a bill to repeal the law but delay implementation for two years to provide Congress a window to develop an alternative.
Ohio Sen. Rob Portman also voiced concerns and others were expected to follow.
“I did not come to Washington to hurt people,” Capito said in a statement.
Murkowski urged senators to “take a step back and engage in a bipartisan process to address the failures of the ACA and stabilize the individual markets. That will require members on both sides of the aisle to roll up their sleeves and take this to the open committee process where it belongs.”
The repeal-and-delay plan would cause even more widespread disruption to the nation’s healthcare system and throw millions more Americans off the insurance rolls, according to the nonpartisan Congressional Budget Office.
McConnell signaled Tuesday he would nevertheless bring up the repeal-and-delay legislation for a vote early next week.
But that appears to be mostly a show vote, as it doesn’t have enough support for passage.
“This has been a very, very challenging experience for all of us,” McConnell said at the Capitol. “We have demonstrated that Republicans, by themselves, are not prepared at this particular point to do a replacement.”
That means that the next chapter of the healthcare debate may unfold in the more conventional setting of a congressional hearing room, a venue that McConnell shunned as he crafted his repeal legislation behind closed doors.
Alexander said he would hold committee hearings soon. “However the votes come out on the healthcare bill, the Senate Health Committee has a responsibility during the next few weeks to hold hearings to continue exploring how to stabilize the individual market,” he said.
Washington Sen. Patty Murray, the ranking Democrat on the committee, said she and her colleagues would be there.
“Democrats are at the table when the Republican-controlled government is ready to actually govern,” she said.