WASHINGTON — With their bill to repeal and replace the Affordable Care Act in tatters, Senate leaders on Tuesday pushed to vote on a different measure that would repeal major parts of President Barack Obama’s health law without a replacement — but that plan appeared also to collapse.
Sens. Susan Collins of Maine, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska, all Republicans, immediately declared they could not vote to repeal the Affordable Care Act without a replacement — enough to doom the effort before it could get any momentum.
“I did not come to Washington to hurt people,” Ms. Capito said in a statement. “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 hinted strongly that he too would oppose it.
The collapse of the Senate Republican health bill — and the failing struggle to find yet another alternative — highlighted a harsh reality for Senate Republicans: While Republican senators freely assailed the health law while Mr. Obama occupied the White House, they have so far not been able to come up with a workable plan to unwind it that would keep both moderate Republicans and conservatives on board.
By midday Tuesday, the Republican Party’s seven-year-old promise to repeal the Affordable Care Act appeared broken. At the White House, President Trump said his plan was now “to let Obamacare fail,” suggesting Democrats would then seek out Republicans to work together on a health measure.
“It will be a lot easier,” Mr. Trump said, adding, “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.”
Sen. Mitch McConnell of Kentucky, the majority leader, gamely pressed forward on Tuesday even as the ground was giving way beneath him.
“I regret that the effort to repeal and immediately replace the failures of Obamacare will not be successful,” Mr. McConnell said on the Senate floor on Tuesday morning. “That doesn’t mean we should give up. We will now try a different way to bring the American people relief from Obamacare.”
On Capitol Hill, Republicans and Democrats alike were trying to make sense of the bill’s downfall — and what comes next. On Monday night, two Republican senators, Mike Lee of Utah and Jerry Moran of Kansas, came out in opposition to the bill, leaving Republican leaders at least two votes short of those needed to start debate on the measure.
Two other Republican senators, Rand Paul of Kentucky and Collins, had already said they would not support a procedural step to begin debate.
House Republicans, after their own fits and starts, passed a bill to repeal the Affordable Care Act in May, a difficult vote that was supposed to set the stage for quick Senate action. But with conservative and moderate Republicans so far apart in the Senate, the gulf proved impossible to bridge. Conservatives wanted the Affordable Care Act eradicated, but moderates worried about the effects that would have on their most vulnerable citizens.
The Senate Democratic leader, Chuck Schumer of New York urged his Republican colleagues to begin anew and, this time, undertake a bipartisan effort.
“This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” Schumer said. “Rather than repeating the same failed, partisan process yet again, 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 health care system.”
Roughly 20 million people have gained coverage through the Affordable Care Act. Repealing the law was a top priority for Trump and Republicans in Congress, who say it has driven up premiums and forced consumers to buy insurance they do not want and cannot afford.
The opposition from Paul and Collins to the latest version of the Senate bill was expected, so McConnell had no margin for error as he unveiled it. But he managed to survive through the weekend and until Monday night without losing another of his members — though some expressed misgivings or, at the very least, uncertainty.
McConnell had wanted to hold a vote this week, but he was forced to abandon that plan after Sen. John McCain, R-Ariz., had surgery last week to remove a blood clot from above his left eye. That unexpected setback gave the forces that opposed the bill more time to pressure undecided senators.
Already, McConnell was trying to sell legislation that was being assailed from many directions. On Friday, the health insurance lobby, which had been largely silent during the fight, came off the sidelines to blast as “unworkable” a key provision allowing the sale of low-cost, stripped-down health plans, saying it would send premiums soaring and undermine protections for people with pre-existing medical conditions.
McConnell has now failed twice in recent weeks to roll out a repeal bill and keep his conference together for it. He first wanted to hold a vote in late June, only to reverse course after running into opposition.
House Republicans in competitive districts who supported their version of the bill will now have to explain themselves — and Democrats are eager to pounce.
“Make no mistake, Paul Ryan can’t turn back time and undo the damaging vote he imposed on his conference,” said Meredith Kelly, a spokeswoman for the Democratic Congressional Campaign Committee. “House Republicans all own a bill that would strip health care from 23 million Americans and raise costs for millions more, and it will haunt them in 2018.”
Lee, one of the most conservative members of the Senate, was part of a group of four conservative senators who came out against the initial version of McConnell’s bill after it was unveiled last month. He then championed the proposal to allow insurers to offer cheap, bare-bones plans, which was pushed by another of those opponents, Sen. Ted Cruz of Texas. But the language ultimately added was not quite what Lee had been advocating, his office said after the new bill was released.
Moran, a reliable Republican vote and a past chairman of the Senate Republicans’ campaign arm, had announced his opposition to the bill as drafted after McConnell scrapped plans to hold a vote in late June. He expressed concerns about how it would affect Kansas, including whether it would limit access to health care in rural communities and effectively penalize states, like his, that did not expand Medicaid under the Affordable Care Act.
The pressure on Moran at home showed no sign of relenting. The Kansas Hospital Association said last week that the revised Senate bill “comes up short, particularly for our most vulnerable patients.”