Senate Majority Leader Mitch McConnell has suggested Republicans could take another run at Obamacare repeal next year if they keep their majorities. | Drew Angerer/Getty Images Health Care Would Republicans take another shot at Obamacare? If they hold the House, they may try ‘repeal’ — but again stumble on ‘replace.’

Republicans who just endured months of withering attacks over health care will face an immediate high-stakes decision if, against all odds, they keep control of the House and Senate: whether to mount one more bid to kill Obamacare that's almost certain to fail.

The GOP believes it can't just walk away from an eight-year pledge to repeal the law, a promise the party's base still wants Republicans to keep despite Obamacare's relative new popularity. If an election-night shocker keeps Republicans in power — rebuking the conventional wisdom that voters will punish them for their Obamacare attacks — they might be emboldened to mount another repeal push without risking reprisals at the polls next time around.


"Nothing concentrates the mind like being shot at and missed," said Tom Miller, a resident fellow at the conservative American Enterprise Institute. "The tendency in that situation would be to say whatever we did worked. So let's keep doing it."

Senate Majority Leader Mitch McConnell suggested last month Republicans could take another run at Obamacare repeal next year if they keep their majorities.

Still, there's little appetite among lawmakers to jump right back into the all-consuming brawl that dealt them their most embarrassing loss of the Trump era and energized Democratic opposition. The party still has no viable health care plan — the "replace" part of repeal and replace. And the math isn't in their favor.

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Even if they hang onto the House on Election Day, Republicans' advantage in the chamber would shrink to just two or three votes under even the rosiest midterm projections, leaving virtually no room for error in rounding up votes for a repeal package guaranteed to be divisive.

A Republican-controlled Congress, with an eye toward reelecting President Donald Trump in 2020, could pursue party-unifying issues instead, like another round of tax cuts Trump dangled before the midterms.

But take up Obamacare repeal again and the GOP would invite another brutal, months-long health care war facing long odds and littered with stumbling blocks.

"The one thing we've learned on health care is that if you're disruptive, you lose," said former Virginia Rep. Tom Davis, who led the NRCC. "It would not be the smart fight to pick."

Any decision will hinge on Trump, who has recently been vowing to protect pre-existing conditions even though his administration joined a 20-state lawsuit aimed at eliminating the Obamacare patient protections — and he lamented just this past Friday that the GOP narrowly failed to gut the law.

Twenty House Republicans (some of whom won‘t be back in 2019) voted against last year's GOP health care bill that passed by just four votes. Moderates worried it went too far to repeal popular provisions, like pre-existing condition protections, and conservatives complained it left too much of Obamacare in place. The bill, which Trump later dismissed as "mean" even after celebrating it in the Rose Garden, was dead on arrival in the Senate. And several variants also collapsed in the Senate.

Crafting a repeal bill would be even tougher this time around. The House GOP conference will grow more conservative next year, as more moderate lawmakers retire or lose swing-district races. That will swell the ranks of the right-wing Freedom Caucus, giving even more sway to the group that nearly derailed Republicans' repeal effort last year for not eviscerating even more of Obamacare.

"The bill that would come through the House would arguably be more conservative" compared with last year, a House Republican aide said. "I just don't see how the path gets easier for us."

That’s a problem in particular for the Senate, where any repeal bill would likely have to win over a combination of hardline conservatives, establishment Republicans and more moderate members, even if the GOP boosts its 51-49 majority by a few seats.

GOP centrist Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) are still likely to be skeptical of any repeal bill. Last year’s third GOP "no" vote, Sen. John McCain, has since died and been replaced by a more establishment Republican. But that addition was effectively canceled out when Democrats flipped an Alabama Senate seat by electing Doug Jones.

House Republican leaders haven't said all that much recently about tackling Obamacare, though they maintained it's deeply flawed. Rank-and-file members vying for their political lives are tacking left in the meantime, insisting they'll preserve pre-existing condition protections they tried to gut last year.

House and Senate aides say there's been little discussion of repeal, despite McConnell's suggestion of a revival. Senate Republicans haven't gotten any closer to 50 votes on a health plan since Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) led a last-ditch effort to repeal Obamacare last fall.

Meanwhile, Trump administration health officials have pivoted from trying to bulldoze Obamacare to championing new policies providing a path around the law, basically making it easier for some people — particularly healthy ones — to buy less expensive health plans without full Obamacare patient protections and comprehensive benefits.

"You've already seen the repositioning," said Miller of AEI, pointing to the administration's attempts to take credit for the improving Obamacare markets.

Yet for all the reasons to run like mad from yet another repeal bid, Republicans refuse to rule out the possibility. That's partly over concerns that abandoning it altogether would enrage their conservative base. Further, they say holding onto the House would amount to an epic rebuke of Democrats' health care message.

"If we hold onto the House, then the Democrats took a big swing and a miss," said Pat Brady, a Republican consultant and former Illinois GOP chair.

That could be enough to convince a newly energized GOP to take another shot. While the path to any major Obamacare repeal is tightrope-thin, Republicans say it's not impossible.

The push would need to start in the Senate, where Republicans could leverage their slightly larger majority to refine the Graham-Cassidy blueprint, which would block grant most Obamacare funding and give states significant new flexibility to customize their health insurance markets.

Senators would still need to sell the House on a plan that won't be conservative enough for many in the lower chamber. However, conservative lawmakers could decide to live with it if they determine it's their last best chance to whack the law and keep a campaign pledge.

"They more or less antagonized the half of Americans who wanted to repeal the ACA, and the other half who are mad at them for trying," said Doug Badger, a senior fellow at the Galen Institute. “The best way to get around that is to actually do something positive."

Even then, it'd still be a long-shot that would eat up months of time and play to Democrats' advantage in 2020. The opposition from Democrats and activists who are now veterans of the health care fight could dwarf last year's debate.

Republicans, who've recently promised on the campaign trail to guard pre-existing conditions, could risk instant backlash if they embrace anything less than Obamacare's robust protections.

"For the like, four moderates that are left in Congress after this election, I think they're going to be very, very reluctant," one health care lobbyist with ties to the GOP said of attempting a full repeal.

But the most ardent repeal advocates argue that if they can save their House majority on Tuesday against the odds, then tackling a massive health care overhaul suddenly may not seem so far-fetched.

"It is unfinished business," said Badger. "When the dust clears ... if in fact Republicans are still in the majority in both houses of Congress, then we certainly want to talk about it."