Republican leaders are battling to avert another healthcare setback for President Donald Trump as they rally support for a second attempt at reform under pressure from the White House.
In the latest Trump administration gamble, senior White House officials have predicted a vote to overhaul Obamacare this week even though party chiefs on Tuesday did not have enough support to pass a bill.
The White House is seeking the kind of big legislative victory that eluded it in the president’s first 100 days. But Republicans are still struggling to bridge internal divides over the cost and breadth of healthcare insurance.
Joe Minarik, a healthcare expert and former senior economist in the Clinton administration, said Mr Trump was banking on someone being able to strike a compromise between two often intractable party factions.
“It basically reminds me of some sporting events you watch,” he said. “You see somebody making a very risky play and you don’t know whether it’s going to come off. If it comes off the guy’s a genius. And if it doesn’t come off he’s an idiot.”
Republicans’ inability to strike a deal at the end of March led to the humiliating withdrawal of a previous healthcare bill before it came to a vote in the House of Representatives, a low point of Mr Trump’s first 100 days in office.
Mr Trump made repealing Barack Obama’s reforms a key campaign pledge, but he has run into conflict between conservatives whose priority is scaling back government’s role and moderates who oppose doing so if it robs people of insurance.
Paul Ryan, the speaker of the House, presented a positive front on Tuesday, saying “the president’s been nothing but helpful on healthcare” as the House majority whip Steve Scalise said “we’ve been making important progress” on gathering votes.
But Mark Meadows, head of the Freedom Caucus group of conservative lawmakers, said Republicans were still “a handful of votes away” from being able to pass a reform bill given that all Democrats were planning to vote against it.
The odds of passage worsened when Fred Upton, a moderate Republican lawmaker who is influential on healthcare issues, said he would vote against the legislation because it undermined protections for people with pre-existing illness.
One Republican aide on Capitol Hill said: “The White House is trying to pressure [lawmakers] through the media. I don’t think any lawmaker takes well to the president telling them ‘you will vote on this’.”
Grace-Marie Turner, who advises Republican lawmakers on healthcare as president of the Galen Institute think-tank, said: “Obamacare handed Republicans a bucketful of hand grenades and they are now trying to work out how to stop them going off.”
Republicans agree that Obamacare was riddled with problems, but the latest sticking point is over whether Americans with pre-existing medical conditions should be guaranteed access to health insurance, a right created by Mr Obama’s law.
Conservatives are against the guarantee and moderates are for it, leaving Republican leaders searching for a compromise by deferring decisions on the issue to state governments.
“I want [the bill] to be good for sick people,” Mr Trump said in an interview with Bloomberg News this week. “It’s not in its final form right now. It will be every bit as good on pre-existing conditions as Obamacare.”
Mike Pence, vice-president and a former congressman, was due to spend Tuesday afternoon on Capitol Hill wooing lawmakers. On Monday, Gary Cohn, Mr Trump’s top economic adviser, said: “This is going to be a great week. We’re going to get healthcare to the floor of the House.”
Ms Turner said Republicans’ healthcare struggles stemmed partly from the fact they had done a poor job explaining to voters what their proposals would mean.
“They’ve not had enough time to spend on core messaging to persuade people that you are going to be OK, that [Obamacare] is going to stay in effect while we move to a better system,” she said.