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(Amber Ferguson/The Washington Post)

The Republican Partys seven-year quest to undo the Affordable Care Act culminated Friday in a humiliating failure to pass an unpopular bill, sparking questions about how steep the costs will be for its congressional majorities.

While lawmakers have not completely abandoned the effort, they are now confronting the consequences of their flop. Not only has it left the GOP in a precarious position heading into next years midterm elections, but it also has placed enormous pressure on the party to pass an ambitious and complex overhaul of federal taxes.

Strategists argued for months that Republicans risked more by not acting and alienating their conservative base than by passing an unpopular repeal bill that could turn off swing voters. They now live in the worst of both worlds with nothing to show for seven years of campaign promises, even though dozens of vulnerable lawmakers cast votes that could leave them exposed to attacks from Democrats.

This is an epic failure by congressional Republicans, said Tim Phillips, president of the conservative Koch network group Americans for Prosperity. But its time to pivot to tax reform. Theres no time to pout.

In the moments after the bare-bones repeal bill failed early Friday morning, Senate Majority Leader Mitch McConnell (R-Ky.) said it was time to move on. But there seemed to be little stomach afterward among Republicans on Capitol Hill for acknowledging outright failure on their top campaign promise.

Lawmakers did agree, however, that when they return to Washington after Labor Day, they must succeed in their rewrite of the tax code after seven months that have seen too many of their top agenda items untouched.

Weve asked the voters for a lot, said Rep. James B. Renacci (R-Ohio), who is leaving Congress after his current term to run for governor. Theyve given us the House. Theyve given us the Senate. Theyve given us the presidency. Its time to give them something back and get something done.

Off the Hill, the collapse of the repeal effort has left conservative activists fuming about how the GOP could have flinched and pondering payback for the party establishment particularly several moderate senators who voted for ACA repeal legislation when it had no chance of becoming law only to balk when it did.

In campaign after campaign since the ACA was enacted in 2010, GOP candidates used pledges to repeal and replace Obamacare to gain majorities in the House and Senate, and President Trump promised to unravel the law as one of his first acts in office.

Instead, Republicans have continually failed to coalesce around an alternative vividly demonstrated by the dramatic failure of the skinny repeal on the Senate floor early Friday morning. They appear trapped in the fallacy of sunk costs: Having invested so much political capital in the ACAs repeal, they cannot possibly abandon it.

Numerous House lawmakers leaving a closed-door Republican conference meeting hours after the Senate bill collapsed said that efforts to undo the increasingly popular health law would have to continue.

I am disappointed and frustrated, but we should not give up, House Speaker Paul D. Ryan (R-Wis.) declared.

Rep. Mark Meadows (R-N.C.), the leader of an influential bloc of House conservatives, insisted a deal was still within reach and said hed approached key senators. And while Trump said he would let Obamacare implode, he also urged senators on Twitter to jettison their filibuster rules to pass really good things.

But key figures warned Republicans to move on before the health morass sinks the rest of the partys agenda most importantly, the tax overhaul.

Quarantine it, said Josh Holmes, a GOP strategist and former chief of staff to McConnell who coined the repeal and replace mantra in 2010. You can let it destroy your entire agenda and your entire party as a result of inaction by continuing to dwell on something that, frankly, theyve proven unable to do.

But conservative activists have been furious in the aftermath of the repeal vote and have cast about for ways to punish those they consider responsible.

The three Republican senators who cast the decisive votes on Friday Susan Collins of Maine, John McCain of Arizona and Lisa Murkowski of Alaska are largely immune to immediate electoral consequences. Murkowski, who withstood public pressure from Trump, is less than a year into a six-year term; McCain, also reelected last year, is battling an aggressive form of brain cancer; and Collins, who has not faced a serious primary threat since 1996, next stands for reelection in 2020 and is considering a run for governor next year.

But activists are still angry that several other Republican senators Dean Heller (Nev.), Lamar Alexander (Tenn.), Shelley Moore Capito (W.Va.) and Rob Portman (Ohio), as well as McCain and Murkowski voted for an ACA repeal measure in 2015, when President Obama was certain to veto it, but opposed an almost identical measure this week knowing Trump could sign it into law.

That level of cynicism is breathtaking, even in the political world, said Phillips of Americans for Prosperity, which helped drive the public backlash to the ACA ahead of the 2010 Republican congressional wave.

Only Heller faces reelection next year, however, and he has yet to attract a conservative primary challenger despite emerging as a key swing vote who pushed to reduce the scope of the Senates efforts.

Adam Brandon, president of the conservative activist group FreedomWorks, said Heller opened himself wide open to a primary challenge: By bending over backwards to save Medicaid expansion, to preserve the fastest-growing entitlement program in the United States, what conservative, Republican, libertarian constituency were you serving?

Brandon, whose group deemed the turncoats Freedom Frauds, said the events of the past months have revealed a party with a double standard in handling its right flank versus its more moderate faction.

Had the Senates leading conservatives tanked the health bill, he said, they would be recruiting someone to primary Mike Lee and Rand Paul and Ted Cruz, but thats not happening with Collins, McCain and Murkowski. He also suggested that the committee chairmanships held by the trio ought to be at risk.

In the House, the political challenge posed to Republicans is the opposite: Dozens of members targeted for defeat by national Democrats voted for the American Health Care Act, the GOP bill judged by the Congressional Budget Office to result in higher premiums for older and sick Americans.

Democrats made clear they intend to use that vote in their 2018 campaigns, even if the bill was never ultimately made law.

House Republicans cant turn back time and undo the morally bankrupt vote they took to kick 23 million Americans off their health insurance, impose an unfair age tax and cause skyrocketing premiums, said Tyler Law, a spokesman for the Democratic Congressional Campaign Committee. Speaker Ryan and all House Republicans own their disastrous bill, and it will certainly haunt their imperiled Republican majority in 2018.

On the flip side, House Republicans who cast votes for the bill cannot point to any finished product that might motivate more conservative voters. Rep. Steve Stivers (R-Ohio), the chairman of the National Republican Congressional Committee, insisted that the circumstances surrounding the health bill would actually work to the GOPs benefit.

Our base knows what we did, Stivers said. But it also isnt going to become law, so ... I think they have a hard time really punishing our members for some theoretical details.

A handful of moderate Republican lawmakers said Friday they would be open to pursuing a bipartisan fix to the ACA. But for most rank-and-file Republicans, the approach is simple: Never say die.

Its only a defeat if we surrender, said Rep. Barry Loudermilk (R-Ga.). Look, the U.S. Navy was devastated at Pearl Harbor, but three years later the Japanese surrendered to us. ... The history books of America are marked by us rebounding from defeat and turning it into victory. Were going to keep pushing.

Inside the closed-door conference meeting Friday, Rep. Bruce Poliquin (R-Maine) showed his colleagues clips of early Atlanta Falcons touchdowns in this years Super Bowl a game won by the New England Patriots after a furious 25-point comeback.

Plenty of House members showed a willingness to hang the health bills failure on the Senate, which due to its filibuster rules has yet to take up or pass dozens of significant House bills. In a final meeting before a five-week summer recess, Ryan told his colleagues that they represented the most functional branch of government.

But several House members said they were skeptical House Republicans would be able to separate themselves from the other chamberss failure and feared that they, too, would suffer from a dejected GOP base.

Rep. Mike Bost (R-Ill.), who represents a blue-collar downstate district Democrats are heavily targeting in 2018, said he rarely encounters a constituent who airs frustrations with a particular chamber.

They never say, Well, its the Senate or the House. What they say it is, Its Congress, he said. I cant change who the Senate is, okay? But I can keep doing my job, and thats what I intend to talk about.

Read more at PowerPost

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Republicans' failure to 'repeal and replace' Obamacare may cost them at the ballot box - Washington Post

The beginning of General John Kellys era in the White House looks indistinguishable from the end of the Reince Priebus era.

After pushing out his diminished chief of staff Friday afternoon and replacing him with Kelly, a retired four-star Marine general and outgoing Secretary of Homeland Security, President Donald Trump began his Saturday as he has many weekend mornings when he is not playing golf: on Twitter, casting blame elsewhere for the setbacks of the week.

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In a series of tweets, Trump railed against the Senate for failing in its second attempt to overhaul Obamacare, which left the president with no legislative accomplishment to point to six months into his administration. The very outdated filibuster rule must go, Trump wrote on Twitter, noting that Republicans look like fools by allowing 8 Dems to control the country.

Its not the first time Trump has suggested ending the legislative filibuster -- and its something Senate Republicans have immediately dismissed when he has raised the idea in the past. In May, Senate Majority Leader Mitch McConnell told reporters that ending the legislative filibuster was flat out not going to happen. Republican Sen. John Kennedy added at the time: Im not going to support a change in rules. The Founding Fathers set it up this way.

But for Trump, the legislative process was the scapegoat for his biggest legislative setback to date -- one that thrusts him into August with Republicans on the Hill trying to start from scratch on repealing and replacing Obamacare, while many in the White House want to move on to tackle tax reform.

After Sen. John McCain (R-Ariz.) voted against the Republican healthcare bill late Thursday night, Hill staffers braced themselves for the president to take out his anger on McCain, a former Trump antagonist who earlier this month announced he has brain cancer. Trump was uncharacteristically quiet on that front. But on Saturday morning, it was McConnell whom he singled out, instead, on his Twitter feed.

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Budget reconciliation is killing R's in Senate, Trump tweeted. Mitch M, go to 51 Votes NOW and WIN. IT'S TIME!

Nowhere in Trumps tweets urging Republicans to MAKE CHANGE! and switch to a 51 majority vote did he acknowledge that the failed Republican legislation only had 49 votes.

Though Republicans hold a 52-seat majority in the Senate, three GOP senators -- Sen. Lisa Murkowski, Sen. Susan Collins and McCain -- broke from the ranks and voted, along with Democratic lawmakers, to strike down the so-called "skinny" Obamacare repeal legislation. McConnell was trying to pass the legislation through budget reconciliation, which would have only required a simple majority of votes to pass.

8 Dems totally control the U.S. Senate, Trump tweeted on Saturday. Many great Republican bills will never pass, like Kate's Law and complete Healthcare. Get smart!

The morning tweetstorm appeared motivated primarily by the failure of the healthcare bill, and by Trump's frustrations with the legislative process and particularly with McConnell, who White House officials said told them to stay out of the healthcare fight and let the tactician of the Senate handle the nuts and bolts of pushing through the legislation.

But it also came after a two-week stretch of chaotic changes in the White House. A week ago, press secretary Sean Spicer resigned abruptly from his position, after Anthony Scaramucci, a former hedge fund manager and Trump campaign fundraiser, was named communications director. Scaramucci, who opened his tenure in the White House with a profane rant to a reporter from the New Yorker about Priebus and chief strategist Steve Bannon, has vowed a broad overhaul of the communications shop, that will include firing anyone thought to be a leaker.

Son-in-law Jared Kushner, meanwhile, spent the first half of last week in closed-door sessions with the House and Senate intelligence committees being grilled about his dealings with Russian operatives during the campaign and the transition. Trump, meanwhile, has continued to publicly berate his Attorney General, Jeff Sessions, who has drawn the president's ire for recusing himself from the ongoing Russia investigation. That tiff has forced a split in his own party as Republicans inside and outside the administration warn the president of the folly of firing one of his earliest campaign supporters.

And lost in all the noise coming from inside Trumps White House was an announcement from North Korea that its latest intercontinental ballistic missile test showed that the entire mainland of the United States is now within striking range.

But the president has something on the calendar to buck up his flagging spirits. In the middle of the turbulent week of changes, many of them long discussed and overdue, Trumps campaign announced the president would travel to West Virginia on Thursday to participate in one of his favorite activities: a good, old-fashioned campaign rally.

Brent Griffiths contributed to this report.

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Trump marks new Kelly era with sharp attack on Republicans - Politico

The Koch groups are expected to provide key financial support and political pressure for lawmakers as they return to their home districts next month seeking to demonstrate progress on one of the centerpieces of the Republican agenda. The groups said they are planning to organize grass-roots events across the country as well as invest in paid ads.

Monday's event will also include volunteers working phone banks to urge lawmakers to pass comprehensive tax reform. On Thursday, Freedom Partners began highlighting 10 senators who previously had supported changes to the tax code, starting with Sen. Joe Manchin of West Virginia. Together, the groups already have spent hundreds of thousands of dollars on digital ads targeting members of the tax-writing committee in the House this summer.

But the Koch groups and Republican leadership have not always been on the same page.

The groups were among the most vocal opponents of the border adjustment tax, which would have allowed U.S. companies to deduct the cost of domestic production but not imports effectively raising the cost of foreign goods. GOP leadership argued the provision was critical to keeping U.S. companies from moving overseas and also raised a trillion dollars in revenue to help pay for a lower corporate tax rate.

But the Koch groups dubbed the measure a new tax on consumers, even organizing a protest against House Ways and Means Chairman Kevin Brady as he delivered a speech at a Washington hotel. AFP spent six figures on a cable TV ad this spring that compared the measure to the taxes in the Affordable Care Act, while Freedom Partners funded research on the state-level impact of the border adjustment tax.

On Thursday, the Republican leadership announced in a joint statement with the White House that it would abandon the measure to focus on the broader goals of tax reform. Freedom Partners cheered the move as a "welcome step."

Speaking to reporters Thursday, Brady said he planned to retreat next month with members of his committee and the Senate to Rancho del Cielo in California, which served as a vacation home for President Ronald Reagan, to begin work on a tax bill.

"It shows we are uniting behind bold principles of tax reform," Brady said. "It makes clear there is an urgency to deliver it this year, and it's clear the president is fully committed to this tax reform approach."

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The Republican tax reform effort just won some important support - CNBC

In a Washington that has grown demonstrably more testosterone-fueled since President Trumps inauguration, it took two Republican women to secure the end of a long effort to repeal and replace Obamacare.

They were the same two women Maine Sen. Susan Collins and Alaska Sen. Lisa Murkowski who had been excluded from the 13-member working group drafting the Republican bills.

Nobodys being excluded based upon gender. Everybodys at the table, Senate Majority leader Mitch McConnell had said of his all-white-males group.

In the early hours of Friday morning, the duo was overshadowed by the more dramatic and unexpected no vote from Sen. John McCain of Arizona.

There was reason for the attention lavished on McCain a war hero and veteran senator returns to the Capitol days after a dire cancer diagnosis. But without both Collins and Murkowskis steadfast opposition, his vote would have been meaningless.

Also largely overlooked: Hawaii Sen. Mazie Hirono, a Democrat who voted against the bill. Like McCain, she was recently diagnosed with cancer, in her case late-stage kidney cancer.

Social media buzzed Friday with praise for the women senators from many fronts, including from men. But from many women, there was also a sense of familiarity at being ignored or taken for granted.

To a tweet pointing out the GOP senators exclusion at the beginning of the Senates healthcare effort and the attention focused elsewhere during the vote, Shawnda Westly, a Democratic strategist from California, joked: Im so surprised! Said no women ever reading this tweet.

It's been true throughout history that great men make a difference only due to great women, added former California congresswoman Ellen Tauscher.

If there was an edge to a desire for recognition, it may have come from the times. A quarter century removed from the Year of the Woman the 1992 election that dramatically increased the numbers of female representatives politics remains difficult to navigate for women.

They are supposed to be strong but not overbearing; professional, but nurturing. Criticisms they offer tend to be judged more harshly than those coming from men, research shows, so the act of seeking and keeping political office is fraught. Their voices are suspect, and their clothing and hairstyles still analyzed.

The numbers of women in high elective office have stalled in recent years; only 21 members of the Senate are female, five of them Republicans.

Women comprise less than a quarter of elected officials in state legislatures, statewide elective office and in the House and Senate, according to figures compiled by the Center for American Women and Politics at Rutgers University.

In both parties, women have to fight being invisible.

During President Obamas first term, women on his staff invented a system called amplification. If an idea was offered by a woman in a meeting to no notice, another woman would repeat it with credit given to the originator.

The Trump Administration includes some senior women, including the presidents daughter Ivanka, counselor Kellyanne Conway and press secretary Sarah Huckabee Sanders. But the administrations visage has been mostly male, and its attitudes combative.

Signing ceremonies for important measures including one on abortion have included only men. A photo of dozens of Trump advisors gathered for a meeting went viral for including only men.

The president had trouble during the campaign with what his aides euphemistically called locker room talk. On Thursday, as the healthcare vote neared, the administration was convulsed by incoming communications director Anthony Scaramuccis vulgar throwdown against his competitors for White House power, which included a sexual reference to White House advisor Steve Bannon.

Kelly Dittmar, an assistant professor of political science at Rutgers, said that women in Congress interviewed for a recent report showed frustration at being sidelined.

Perhaps men are taking more credit or being given more credit, she said. But, she added, most of the women adopted the view that Were really not here to claim credit; were here to get things done.

That seemed to be the case with Murkowski and Collins, both of who came under sharp criticism during the healthcare push.

Neither party has a monopoly on good ideas, and we must work together, Collins said after the vote, a sentiment Murkowski also put forth.

Neither senator mentioned her own gender during the vote or its aftermath, but others cited them as demonstrating the need for different types of legislators.

Every woman has had that experience of being shut out of an important discussion, and then being called out for being too aggressive or ambitious when we edge our foot in the door, Westly said. What we should be talking about is why women are a crucial perspective to the conversation.

Those working to persuade more women to run for office have noted a giant upswing in interest since Trumps election. Most of it, however, has come among Democrats, where women are better represented, if still not anywhere near parity with men.

There was some anticipation, at least, that Collins and Murkowskis role in the healthcare debate would draw notice, particularly among women like them.

I would hope that it does demonstrate the role that women and in this case more moderate women can play in elective office, said Dittmar. What we have seen in the last decade or more is a decline in number of moderate Republican women running, and that means that were missing that whole contingent.

For more on politics from Cathleen Decker

cathleen.decker@latimes.com

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In a Washington run by men, two overshadowed Republican women make their point on healthcare - Los Angeles Times

WASHINGTON (Reuters) - The seven-year Republican quest to scrap Obamacare, a major campaign vow by President Donald Trump, lay in ruins on Friday after the Senate failed to dismantle the healthcare law, with congressional leaders now planning to move on to other matters.

John McCain, the maverick 80-year-old senator and 2008 Republican presidential nominee, cast the deciding vote in the dramatic early-morning showdown on the Senate floor as a bill to repeal key elements of Obamacare was defeated, 51-49, dealing Trump a crushing political setback.

McCain, who flew from Arizona this week after being diagnosed with brain cancer and was heading back for further treatment starting on Monday, joined fellow Republicans Susan Collins and Lisa Murkowski in voting with Senate Democrats unified against the legislation.

"It's time to move on," Senate Majority Leader Mitch McConnell, whose reputation as a master strategist was diminished, said on the Senate floor after the vote at roughly 1:30 a.m. (0530 GMT).

While House of Representatives Speaker Paul Ryan said fellow Republicans should not give up on healthcare, he cited other pressing issues that needed attention, including major tax-cut legislation sought by Trump.

"We have so much work still to do," Ryan said in a statement.

The Senate's healthcare failure called into question the Republican Party's ability to govern even as it controls the White House, Senate and House of Representatives.

Trump has not had a major legislative victory after more than six months in office, and his administration is mired in investigations into contacts between his election campaign and Russia and high-level White House staff infighting. He had promised to get major healthcare legislation, tax cuts and a boost in infrastructure spending through Congress in short order.

Also on the legislative agenda are spending bills for the fiscal year beginning Oct. 1 to avoid a government shutdown and raising the U.S. debt limit.

Speaking in Brentwood, New York, on Long Island, Trump expressed dismay at the bill's failure, saying, "I said from the beginning, let Obamacare implode and then do it (pass legislation). I turned out to be right. Let Obamacare implode."

Trump, who earlier on Twitter said the three Republicans who voted no "let America down," again took aim at lawmakers in his own party. "Boy, oh boy, they've been working on that one for seven years," he said in Brentwood. "Can you believe that? The swamp. But we'll get it done."

Some lawmakers urged a bipartisan effort to buttress the existing healthcare system. With the partisan divide as wide as ever in Washington, it remained to be seen if a bipartisan approach can get off the ground.

McCain said the defeated bill did not offer meaningful reform and that its defeat presents "an opportunity to start fresh" on legislation crafted by lawmakers in both parties.

"I encourage my colleagues on both sides of the aisle to trust each other, stop the political gamesmanship and put the healthcare needs of the American people first," McCain said.

Top congressional Democrats urged a bipartisan effort to fix problems in the Obamacare law without repealing it. "Change it, improve it, but don't just take a knife and try to destroy it and put nothing in its place," top Senate Democrat Chuck Schumer said.

Democratic Senator Bill Nelson said he was working with Republican Collins on a bipartisan effort on healthcare.

While Ryan was able to secure House passage of a comprehensive bill to gut Obamacare in May, McConnell earlier in the week was unable to win passage of similarly broad healthcare legislation amid intraparty squabbling and competing demands by hard-line conservatives and moderates. On Friday morning, he failed to get even a stripped-down, so-called skinny bill over the finish line.

Killing the Affordable Care Act, Democratic former President Barack Obama's signature domestic policy achievement dubbed Obamacare, has been a passion for Republicans since its 2010 enactment over their unified opposition, and was a key campaign promise by Trump last year.

Republicans lawmakers, some of whom have been gleeful about razing Obama's presidential legacy, now fear a backlash from their conservative political base that could affect the 2018 congressional elections.

For the moment, the Affordable Care Act, which extended health insurance to 20 million people and drove the percentage of uninsured people to historic lows, remains in place and must be overseen by an administration that is hostile to it.

This leaves health insurers unsure of how long the administration will continue to make billions of dollars in Obamacare payments that help cover out-of-pocket medical expenses for low-income Americans.

Schumer warned against any efforts to sabotage the law.

The Blue Cross Blue Shield Association, which represents insurers across the country, said it would work to ensure a smooth open enrollment period from Nov. 1-Dec. 15 and stabilize the individual insurance market under Obamacare for the long term.

Shares of health insurers, which had fought against the bill's proposed repeal of the mandate that Americans obtain insurance, were up. Aetna Inc rose 0.9 percent, Anthem Inc gained 2.3 percent and Humana Inc edged up 0.2 percent.

On Wall Street, shares of hospitals were mostly higher because of the dwindling prospects for big cuts in the Medicaid insurance program for the poor and disabled. Community Health Systems Inc rose 2.2 percent, HCA Healthcare Inc gained 0.6 percent and Tenet Healthcare Corp edged up 0.1 percent. Republicans have long denounced Obamacare - which expanded Medicaid and created online marketplaces for individuals to obtain coverage - as an intrusion by government on people's healthcare decisions.

Veteran House Republican Tom Cole said he thought there were "a number" of other Republican senators who were uncomfortable with the Senate's healthcare legislation but were able to vote "yes" knowing McCain's vote would kill it.

Republican Senator Lindsey Graham, a close friend of McCain, met on Friday with Trump to discuss Graham's proposal to take tax money raised by Obamacare and send it back to the states in the form of healthcare block grants, the senator's office said.

The skinny bill, released just three hours before voting began, would have retroactively repealed Obamacare's penalty on individuals who do not obtain health insurance, repealed for eight years a penalty on certain businesses that do not provide employees with insurance and repealed a tax on medical devices until 2020.

Reporting by Susan Cornwell and Richard Cowan; Additional reporting by Doina Chiacu, Roberta Rampton, Yasmeen Abutaleb, Rodrigo Campos, Amanda Becker, David Morgan and Eric Walsh; Writing by Will Dunham; Editing by Frances Kerry and Jonathan Oatis

Link:
Republicans try to pick up the pieces after healthcare defeat - Reuters