Donald Trump said Republicans should “let Obamacare fail”, after the dramatic collapse of efforts to repeal and replace Barack Obama’s Affordable Care Act (ACA).

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The president spoke as a new plan to simply repeal the 2010 law with no replacement was in effect strangled at birth by a deeply divided party. This followed the withdrawal of legislation, blindsiding the president, on Monday night.

Venting his frustration, Trump said: “Let Obamacare fail and it will be a lot easier. And I think we’re probably in that position where we’ll let Obamacare fail. 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 made the repeal and replacement of the ACA a central promise of his election campaign. Republicans, driven by ideological zeal, have spent seven years vowing to wipe out Obama’s signature legislative achievement. But they have been far less clear about their alternative.



Their failure means that Trump will mark six months in office on Thursday without a major legislative achievement, despite Republicans controlling the White House, Senate and House of Representatives.

The president received a chastening lesson about the limit of his power on Monday night as he hosted senators for a White House dinner, reportedly of steak and succotash. Even as he warned guests of the dire consequences of failing to kill the ACA while they control the both chambers of Congress, two senators who were not invited were preparing statements that would essentially grant it a stay of execution.



Mike Lee of Utah and Jerry Moran of Kansas took the White House by surprise. The pair joined Susan Collins of Maine and Rand Paul of Kentucky in opposing the bill.

The defections left the Senate majority leader, Mitch McConnell, without enough votes to pass the bill. McConnell conceded in a statement at 10.47pm: “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful.”

McConnell on Tuesday vowed to bring repeal legislation to the Senate floor in the coming days, but this also fell apart when on Tuesday three Republicans – Collins, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska – came out against it, amid worries that repealing the healthcare law without a replacement would cause turmoil in insurance markets.

“I want this game plan explained to me,” Ron Johnson, a conservative senator from Wisconsin, told reporters on Capitol Hill, refusing to say if he still had faith in McConnell.

In a floor speech on Tuesday evening, McConnell said that he would hold a vote to open debate on a measure to repeal the ACA “early next week”, even though it is expected to fail. The decision to press ahead with a vote next week was made after consultation with his conference as well as a discussion with the president and vice-president, McConnell said.

During an earlier press conference, the Kentucky Republican brushed aside criticism of his leadership and the process, saying: “This has been a very, very challenging experience for all of us.”



McConnell’s Democratic counterpart, the minority leader, Chuck Schumer, said Democrats remained prepared to work with Republicans on improving the healthcare law “rather than sabotaging it”.



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Obama spent huge amounts of political capital to get the law passed in 2010. About 20 million people have gained coverage. Republicans were vehemently opposed from day one. They won the House in 2010, the Senate in 2014. A year later, the Senate voted to repeal Obamacare – but it was inevitably vetoed by Obama. The House has voted more than 60 times to repeal or alter the ACA, but most of those votes were also merely symbolic.

On Tuesday, the Arkansas senator Tom Cotton told the conservative radio host Hugh Hewitt: “I don’t see how any Republican senator who voted just 18 months ago for this very piece of legislation could now flip-flop 18 months on with Obamacare still inflicting so much harm on Americans, and the fact that we campaigned on this for four straight elections.”

As recently as January, however, Cotton himself warned against repealing the healthcare law without a replacement.

Trump’s arrival on the scene upended the party. He stuck to the “repeal and replace” mantra during the election campaign, but he also promised to protect Medicaid, the government programme that supports the poor, the vulnerable and the elderly. After winning the election, he told a press conference in January: “It will be repeal and replace. It will be essentially simultaneously.

“It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day. Could be the same hour. So we’re going to do repeal and replace. Very complicated stuff.”

But by February, as reality set in, his tone changed. “Nobody knew that healthcare could be so complicated,” he said.

Some House Republicans praised Trump for lobbying them in person and by phone, though others questioned how much he understood about the bill. After their first attempt ended in ignominy, they narrowly passed a bill and celebrated with Trump in the Rose Garden at the White House. Critics saw that as a moment of hubris. Weeks later, Trump privately described the House bill as “mean”, reportedly infuriating many of the members.

Then came wrangling the Senate, where Republicans’ 52-48 majority leaves little room for error. Hopes rested on the shoulders of the wily McConnell. Just as in the House, the first package last month lacked enough support and was withdrawn.

Then, last weekend, 80-year-old Senator John McCain of Arizona had surgery to remove a blood clot from above his left eye and remained in his home state to recover. This accident of history meant momentum was lost.

The Republican effort has been hobbled by a split between moderates concerned about Medicaid cuts and conservatives who want more radical changes. The party has also faced the stark, politically unpalatable possibility that the ACA is a genie that cannot be wished back into the bottle.

McConnell’s failed bill would have left 22 million uninsured by 2026, according to the nonpartisan Congressional Budget Office (CBO), an estimate that many Republicans found toxic and feared put them at risk of a political backlash.

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Some Republican and Democratic state governors, who help oversee the joint federal-state Medicaid programme as well as private health insurers, have resisted efforts to unravel the ACA, which expanded Medicaid in some states and cut the number of uninsured citizens. Congressional Democrats have remained united in opposition.

“The core of this bill is unworkable,” Schumer said, adding that 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 healthcare system”.

Some Republicans signalled on Tuesday a willingness to team up with Democrats to stabilise the marketplace as a temporary fix. But John Cornyn of Texas, the Senate Republican whip, poured cold water on the idea, telling reporters he opposed any “bailout” of insurance companies.



There are, however, two possible consolations for Trump from the latest setback. Projections by the CBO and others suggest that the Republican bill would have hit his own supporters the hardest, in states such as West Virginia. Paradoxically, doing nothing may be better for his base.

Secondly, he is already returning to themes of his anti-establishment election campaign, blaming Washington politicians from both parties for the deadlock.

Mike Pence said on Capitol Hill: “The Senate should vote to repeal now and replace later, or return to the legislation carefully crafted in the House and Senate. But either way, inaction is not an option. Congress needs to step up. Congress needs to do their job and Congress needs to do their job now.”

Republicans vented frustration with colleagues who had previously supported a measure to repeal the healthcare law when Obama wielded the veto power, but were now reluctant to do so. “Everybody’s frustrated – a lot of us are – that we have got a few people running on this when they shouldn’t,” said Richard Shelby, a reliably conservative senator from Alabama, referring to Republicans’ seven years of promises to repeal the ACA.