Updated at 11:35 p.m.
Senate Majority Leader Mitch McConnell now may have to follow through on his recent warning to fellow Senate Republicans that the next step on healthcare is negotiating Obamacare fixes with Democratic Minority Leader Charles Schumer.
That's one possible route for McConnell following Monday night's surprise announcement by two Senate Republicans, Utah's Mike Lee and Kansas' Jerry Moran, that they won't vote to advance the revised GOP bill to repeal and replace the Affordable Care Act. Their decision led McConnell to say he would push the Senate to pass a clean bill, abandoning the Better Care Reconciliation Act, which McConnell personally crafted behind closed doors.
McConnell said Monday evening that "regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful."
There is bipartisan agreement that urgent steps are needed to stabilize the individual health insurance market in some parts of the country, and some Republicans and Democrats have expressed willingness to work together.
But McConnell and House Speaker Paul Ryan are likely to face enormous difficulty in getting a majority of their GOP colleagues to back repairs to a law they have demonized for the past seven years.
Ryan probably would have the harder task, given that House Republicans generally are more conservative than Senate Republicans. If he were willing to support such legislation, he might have to bring the bill up for a floor vote without the support of most of his caucus, relying heavily on Democratic votes. That would anger hard-line conservatives and could jeopardize his position as speaker.
Experts say an ACA repair bill likely would have to include billions in appropriations to continue the payments to insurers for cost-sharing reductions for low-income exchange enrollees; new funding for reinsurance payments to health plans that enroll a disproportionate share of sicker members; new inducements to younger and healthier consumers to sign up for coverage; and additional subsidies to help people who currently don't qualify for subsidies afford premiums and deductibles.
Democrats might have to accept some loosening of the ACA's insurance market rules to make premiums more affordable for younger and healthier customers. But it's not a foregone conclusion that they would accept such trade-offs.
On Monday evening, Lee, an ultraconservative, and Moran, a relative moderate, declared they will not support a motion to proceed with debate on the bill. Maine Sen. Susan Collins and Kentucky Sen. Rand Paul said last week they wouldn't vote for a motion to proceed.
"There are serious problems with Obamacare, and my goal remains what it has been for a long time: to repeal and replace it," Moran said in a written statement. "This closed-door process unfortunately has yielded the" Senate repeal bill, which, he asserted, "failed to repeal the Affordable Care Act or address healthcare's rising costs."
Without those four senators' support, McConnell lacked the 50 votes he needed from among the 52 Republican senators to move forward with his Better Care Reconciliation Act, which had no support among Democrats.
Moran and Collins, another centrist, have expressed strong concerns about the bill's Medicaid cuts and coverage losses, while Paul and Lee have criticized the bill's failure to roll back more of the ACA's insurance regulations and coverage subsidies.
McConnell had delayed action on the bill for at least a week while Sen. John McCain (R-Ariz.) recovers from surgery.
The loss of support from the four senators does not bode well for the GOP's Obamacare repeal effort, since Republicans have very limited time left before they will have to move on to the federal budget and other issues.
McConnell previously said that if the repeal effort fails, Republicans will have to work with Democrats to craft fixes in the ACA-regulated individual insurance markets. He said Monday evening that the Senate will consider the House's American Health Care Act and look to repeal the ACA with a two-year delay.
Several Republican senators, including Wisconsin's Ron Johnson, had expressed anger toward McConnell over the weekend following McConnell's comments that he did not expect the bill's big, future Medicaid cuts to ever be implemented.
