The Senate Republican healthcare bill is dead, and it doesn’t look like it’ll come back

The Republican effort to repeal and replace Obamacare in one fell swoop crumbled on Monday, and another revival doesn’t appear likely.

Republican Sens. Jerry Moran and Mike Lee announced they would oppose a key procedural step to bring the Senate GOP bill, the Better Care Reconciliation Act, to the floor for debate. The two joined GOP Sens. Susan Collins and Rand Paul in opposing the motion.

Republicans needed 50 votes – no more than two defections – to move the bill forward.

Politico reported that President Donald Trump was with other GOP members at a strategy dinner for the bill when Lee and Moran announced their intention to oppose it, blindsiding the White House.

Immediately after the announcement, other Republicans called for the conference to abandon the current track and work on a bipartisan approach.

Senate Majority Leader Mitch McConnell is now scrambling to attempt a repeal-only, replace-later strategy, which could be popular with conservative-leaning members but lose the more moderate side of the conference.

Experts and analysts say that any momentum on a GOP healthcare bill is dead for now, meaning one of Republicans’ biggest promises of the past seven years will most likely remain unfulfilled, at least through next year’s midterm elections.

Wheels fall off

Moran and Lee were the nails in the coffin for the BCRA, which already faced an uncertain future after multiple revisions and a rash of defections.

McConnell found himself stuck as the BCRA faced resistance from both ends of the Republican conference. Moderates didn’t like its cuts to Medicaid and the projections of large coverage losses. Conservatives were frustrated that the regulatory structure and taxes from Obamacare, the healthcare law officially called the Affordable Care Act, were left in place.

Cobbling together a workable compromise became nearly impossible, since any attempt to win over one side invariably left the other less likely to jump on board.

Given the cover provided by Moran and Lee, more Republican senators may soon emerge in opposition to the BCRA and any other healthcare-reform efforts, said Chris Krueger, an analyst at the Cowen Washington Research Group.

“We would be shocked if four was the floor for GOP defections,” Krueger wrote in a note Tuesday. “The Rubicon was crossed, and we suspect a number of other Senate Republicans will begin the bail. Watch McConnell and the Trump Twitter Machine.”

Appetite for ‘repeal only’

The BCRA’s failure has pushed McConnell toward a bold backup plan: a vote on a repeal-only bill that would give Congress two years to come up with a replacement.

Since the bill would go through the budget reconciliation process, only certain aspects of the ACA could be repealed, but they are some of the most important: funding for tax credits to buy insurance, as well as for the Medicaid expansion, and the individual mandate to purchase insurance.

A similar idea taken up by the House in 2015 was scored by the Congressional Budget Office earlier this year. It projected that 32 million more people would go without insurance by 2026 than under the current system if there were no replacement in effect. The CBO separately projected that 22 million and 23 million more people would be uninsured under the Senate and House replacement bills, respectively.

Given the massive projected coverage losses, it’s unclear whether the more moderate-leaning wing of the party would sign on to such a plan. Conservatives could also be repelled by the trade-off in voting to move such a bill forward for consideration.

Already on Tuesday, several Republican senators have expressed resistance to the repeal-only plan, including Sen. Shelley Moore Capito of West Virginia.

“My position on this issue is driven by its impact on West Virginians,” Capito said. “With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”

Sen. Rob Portman of Ohio also expressed concerns in an interview on Tuesday morning.

“If it is a bill that simply repeals, I believe it will add even more uncertainty and the potential for Ohioans to pay even higher premiums, higher deductibles,” Portman told reporters.

Greg Valliere, a chief strategist and longtime political analyst at Horizon Investments, said it probably wouldn’t happen.

“Mitch McConnell probably will not succeed with his Plan B – a repeal of Obamacare, taking effect in two years,” Valliere wrote in a note to clients on Tuesday. “Theoretically, a replacement bill could pass during that period, but if the Republicans couldn’t agree on a replacement for the past seven years, what makes anyone think they can do it in the next two?”

McConnell could pressure holdouts by telling them they voted in 2015 for the same measure, which was ultimately vetoed by President Barack Obama. But that would still be unlikely to sway recalcitrant members.

“The difference between 2015 and now is that Republicans are shooting with real bullets,” one GOP strategist told Business Insider before Monday’s developments. “When you’re doing that these senators want to make sure there aren’t big coverage losses in their states and they’re not hurting constituents.”