Donald Trump had campaigned relentlessly on a pledge to abolish most of the Affordable Care Act. Photograph: (Reuters)
Trump complained about how he was 'let down' by Democrats 'and a few Republicans,' who opposed the latest Republican effort to repeal Obamacare
An angry President Donald Trump railed Tuesday against dissenters in his party who dashed his months-long effort to dismantle Barack Obama's landmark health care law.
Trump fired off a series of early morning tweets complaining about how he was "let down" by Democrats "and a few Republicans," who announced their opposition the previous night to the latest leadership plan to repeal and replace the 2010 Affordable Care Act, also known as Obamacare.
With four Republicans now lined up against Senate Majority Leader Mitch McConnell's health overhaul, the plan has flatlined in the 100-member chamber, where the party could afford only two defectors in order to get the measure passed.
The dramatic implosion effectively means Trump, who marks his first six months in office later this week, has no major legislative victory under his belt, squandering months of political capital.
Trump had campaigned relentlessly on a pledge to abolish most of the Affordable Care Act, proclaiming at an October campaign rally that it would be "so easy" to immediately repeal and replace the law.
But on Monday night he ran into the uncompromising reality of American politics: even with a president's party enjoying a majority in both chambers, crafting and passing landmark legislation can be difficult in the US Congress.
The failure suggests an inability by Trump -- a political neophyte who often highlighted his lack of connections to establishment Washington -- to get members of his own party to fall into line.
Nevertheless Trump put on a brave face, insisting on Twitter that "we will return!"
"As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned," he added.
'Time to start over'
McConnell was by no means giving up. He told colleagues Tuesday that despite "regret" that the effort failed, "I believe we must continue to push forward now".
In the coming days, McConnell will introduce a bill that repeals Obamacare outright, but with a two-year delay of implementation, in order to allow Congress time to craft a replacement.
A straight repeal bill passed Congress in 2015. But that was during Obama's presidency, and Republicans knew they would pay no political price for their votes, as Obama vetoed the measure.
Trump would likely sign such legislation, putting Republicans on the hook for any ensuing disruption to the health care system.
Two years ago, the nonpartisan Congressional Budget Office warned that simply repealing Obamacare would essentially kick 18 million people off health care in the first year compared to current law, a figure that would balloon to 32 million by 2026. That is far above the 22 million that CBO forecast would lose coverage under the latest repeal-and-replace legislation.
Nevertheless, Vice President Mike Pence said Tuesday he and Trump "fully support" McConnell's decision to move ahead with an Obamacare repeal.
But with a number of Senate Republican moderates voicing concern about how the latest bill could adversely impact millions of people insured through Medicaid, the health coverage program for the poor and the disabled, it appeared unlikely that McConnell's repeal bid would win enough support.
"I can not vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians," Republican Senator Shelley Moore Capito said in a statement.
House Speaker Paul Ryan, whose chamber passed its own health reform bill in May, appeared to recognise the quandary the Senate was in, but stressed the commitment Republicans have made to voters over the past seven years. "We've got a promise to keep," he told reporters.
But Ryan hesitated to map out the way forward, because it remained unclear what repeal effort, if any, could pass the Senate.
While Democrats celebrated, Senate Minority Leader Chuck Schumer extended an olive branch to his Republican rivals. "It's time to move on. It's time to start over" on health care, he said.
Schumer called on Republicans to "work with Democrats on a bill that lowers premiums, provides longterm stability to the markets and improve our health care system."