Members of the Trump administration took to TV channels on Sunday to insist they were on track to pass a bill to repeal and replace the current healthcare law and return power to the states to fix an ailing healthcare system.

Fears continued to grow in the moderate wing of the party, however, that the reform could leave millions without coverage, inflict devastating cuts on poorer and older Americans, and cost the GOP dearly at the 2018 midterm elections.



After Republican leaders pushed a revised bill through the House of Representatives that was so rushed several members admitted they had not even read it in full, a battle will now be joined in the Senate. With the party holding a paper-thin majority of just two seats, and with controversy raging around several aspects of the bill, Donald Trump faces an uphill struggle to secure the legislative victory he so desperately craves.

The president used his favorite bullhorn, Twitter, on Sunday to begin the lengthy process of browbeating wavering Republican senators into line.

Republican Senators will not let the American people down! ObamaCare premiums and deductibles are way up - it was a lie and it is dead! — Donald J. Trump (@realDonaldTrump) May 7, 2017

His chief of staff, Reince Priebus, signaled that a more dignified pace of debate might be tolerated in the Senate, in contrast with the unseemly haste of the House. “Everyone is excited and ready to go to work and take the time necessary to look at the bill … No one’s going to be beating down their door,” he said on Fox News Sunday.

But there were already alarming signs for the White House of a groundswell of discontent among moderates that presages a stormy ride in the Senate. Susan Collins, the senator from Maine who is an expert on healthcare, vowed to effectively bin the House bill and start all over again.

Making a veiled dig at the breakneck speed of the passage through the House, she told ABC’s This Week: “The Senate is starting from scratch. We are going to draft our own bill and I am convinced we are going to take the time to do it right. We will come up with a whole new approach.”

The prospect of prolonged debate in the Senate, followed by renewed infighting with House Republicans before arriving at a final viable bill, will fill White House officials with foreboding. But influential moderates indicated that they were determined not to be bullied into accepting terms that they are convinced could hurt the party badly in the midterms.

Reince Priebus signaled that a more dignified pace of debate might be tolerated in the Senate, in contrast with the unseemly haste of the House. Photograph: Susan Walsh/AP

John Kasich, the governor of Ohio who sought the Republican nomination for president, sounded the alarm over the plan to rein back Medicaid expansion. He said that could impact 700,000 people in his state, a third of whom have mental illnesses or experience drug addiction.

“What happens to those people?” he asked on CNN’s State of the Union. “They give you a $3,000 or $4,000 tax credit to buy insurance. What do you think they can buy for that?”

Kasich also raised the other knotty problem that is causing divisions within the Republican party: preexisting conditions. He was derisive about the $8bn subsidy allowed under the House bill to help set up “high-risk pools” to insure people with preexisting medical conditions in states that opt to allow insurance companies to charge higher premiums to such individuals.

“These high-risk pools, they aren’t funded,” Kasich said. “$8bn is not enough. It’s ridiculous. States are not going to opt for that.”

Trump’s health and human services secretary, Tom Price, side-stepped questions over cuts to Medicaid and cover for preexisting conditions. He stuck to his official line, telling CNN: “The winners under Obamacare were the federal government and insurance companies, the winners under the program we provide will be patients and families and doctors.”

Underlying the increasingly bitter fight are concerns that if the legislation ends up hurting millions of Americans the party could itself be punished.

The nonpartisan Cook Political Report has predicted a “midterm wave” against the GOP on a par with the drubbing the Democrats suffered in 2010 – in the wake of Barack Obama passing the Affordable Care Act, better known as Obamacare, in the first place.

Raúl Labrador is jeered at an Idaho town hall event.

On Thursday, when the vote for the House bill was occurring, Democratic representatives goaded their opposite numbers by singing “Na na na na, na na na na, Hey hey hey, goodbye!” House minority leader Nancy Pelosi warned that the provisions of the bill would be tattoed on the foreheads of all those who backed it, saying: “You will glow in the dark on this one.”

As Republican leaders downplayed the threat of a rout in 2018, Priebus, a former chair of the Republican National Committee, went so far as to suggest that voters would thank his party.

The electorate, he said, would “reward the Republicans that sat up and said: ‘We are not going to see the Obamacare system, which is failing and collapsing, continue any longer.”

The speaker of the House, Paul Ryan, who was instrumental in ramming the legislation through, called the bill a “rescue mission”. He told ABC: “We are proud of this effort, it’s us keeping our promises and it’s a lot better than Obamacare.”

But in constituencies across the length and breadth of America, members of Congress can expect to receive the kind of rough ride that met the Idaho Republican Raúl Labrador at a town hall on Friday when he said: “Nobody dies because they don’t have access to healthcare.”

After the comment, his audience erupted in jeers and boos.