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Senate Republicans reconvened behind closed doors Wednesday trying to break the impasse on their healthcare overhaul but emerged with no apparent strategy for resolving differences by an end-of-week deadline.

Senate Majority Leader Mitch McConnell of Kentucky vowed to try again for a vote after the Fourth of July recess, despite having abruptly delayed action this week.

Senators were aiming for a revised bill by Friday, the Republican whip, Sen. John Cornyn of Texas, told reporters, so it could be assessed by the Congressional Budget Office during the break.

But senators remained skeptical after the lengthy lunchtime huddle that appeared to run long on ideas but short on consensus.

I think its going to be very difficult, said Sen. Susan Collins (R-Maine).

McConnell surprised senators by delaying this weeks expected votes once it became clear he did not have a majority for passage or possibly to even open the debate.

As many as 10 Republican senators now publicly oppose the bill, the Better Care Reconciliation Act, and leaders are scrambling to win them over with an estimated $200 billion in savings from the bill that can be applied to their particular states needs.

But even with that fund of resources, it is not clear McConnell will be able to satisfactorily improve the legislation, which now threatens to cut 22 million Americans off health insurance. He can only afford to lose two Republican votes in the face of Democratic opposition.

"It's going to be very difficult to get me to a yes... have to make us an offer we can't refuse, Sen. Dean Heller (R-Nev.) said on a telephone town hall late Tuesday, according tojournalist Jon Ralston, who monitored the call.

Fresh polling Wednesday showed paltry support for the Republican approach to overhauling the Affordable Care Act, known as Obamacare, which has enjoyed a surge in popularity now that Republicans are closer than ever to repealing it. A USA Today poll put approval of the Senate GOP bill at 12%.

Republicans, though, are under enormous pressure from their most conservative supporters and big dollar donors, including the powerful Koch network to deliver on their promised to end Obamacare.

Senate Democrats, meanwhile, suggested that President Trump convene all 100 senators much the way then-President Obama did during his first days in office for a session at Blair House to see how they might be able to work together to improve, rather than repeal, the Affordable Care Act.

Id make my friends on the Republican side and President Trump an offer: Lets turn over a new leaf. Lets start over, said Senate Minority Leader Charles E. Schumer (D-N.Y.).

President Trump, I challenge you to invite us all 100 of us, Republican and Democrat to Blair House to discuss a new bipartisan way forward on healthcare in front of all the American people.

No such invitation, however, seemed forthcoming. Trump dismissed Schumer's proposal "he just doesn't seem like a serious person," the president said and instead promised his own"big surprise" on healthcare.

"Healthcare is working along very well," Trump told reporters at the White House. "We could have a big surprise, with a great healthcare package."

Asked what he meant by a big surprise, Trump simply repeated: "A great, great surprise."

The Republican bill, like its counterpart passed by House Republicans, does not fully gut Obamacare, but rescinds the new taxes imposed on high-incomeindividuals and healthcare companies to pay for expanding coverage through Medicaid and subsidies for private insurance on the ACA marketplace.

Senators said the private talks Wednesday focused mainly on changes to the Obamacare marketplace that could bring down the cost of insurance premiums.

One idea from Sen. Ted Cruz (R-Texas) to allow insurers to offer policies that do not meet the Obamacare benchmarks for what insurance needs to cover met with mixed reaction, senators said.

Sen. Bill Cassidy (R-La.),a physician, warned that such changes would alter the risk pool, keeping insurance costs high.

You end up with policies that, for example, dont cover maternity, Cassidy said. Do you want a policy that doesnt have maternity, which would be principally appealing to young men, when obviously typically men have had a role in that pregnancy?

Other senators were floating new ideas, but McConnell gave no indication whether those proposals would be included in the final revised product.

Michael A. Memolicontributed to this report.

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Senate Republicans aim for new healthcare bill by Friday, but skeptics remain - Los Angeles Times

Such arrangements can work only if private firms trust that the United States will be a reliable partner. Historically, this hasnt been a problem.

That appears to be changing. A decline in trust has already caused health insurers to rethink their relationships with their increasingly erratic federal partner. Theyre demanding higher premiums to account for the greater risk. Blue Cross Blue Shield in North Carolina, for example, has said that its planned rate increase of 23 percent next year would be only 9 percent if it had more certainty from the federal government.

Many other insurers have abandoned these partnerships altogether. According to Health Secretary Tom Price, 49 counties wont have a single insurer on the exchanges in 2018.

Why are insurers so skittish? Though much maligned, insurers in the individual market have a tough job. When they set premiums, they have to guess how much health care their enrollees will need. If they set premiums too low, theyll lose their shirts. Too high, and they wont get customers.

Before Obamacare, insurers protected themselves from risk by gathering medical information and screening out people with pre-existing conditions. When Obamacare put a stop to that, insurers were in a bind. They had to set premiums without knowing in advance how sick their customers were. Thats not easy to do which explains much of the fragility of the exchanges over the past three years.

Lawmakers feared all this uncertainty would cause insurers to stay out of the newly formed insurance exchanges. So Obamacare employed a number of tools in particular, financial subsidies and a mandate requiring all individuals to get insurance to reassure firms that the market would be stable and healthy.

Even with protective policies in place, insurers took a big risk entering the markets. At a minimum, insurers that took the plunge deserved the support promised in the law. Congressional Republicans, however, chose instead to sow uncertainty at every turn, hoping that a damaged reform law would be easier to repeal.

These efforts began soon after Obamacare was signed into law. To shield insurers from unexpectedly large losses, the law created a temporary risk corridor program: an upfront financial commitment from the government. Republicans denounced this as a bailout and eventually used an appropriations measure to prohibit the Obama administration from making the promised payments.

As a result, insurers are owed well in excess of $10 billion. Many have sued to recover the payments.

The governments refusal to pay weighs heavily on insurers as they confront two new problems. First, theres the individual mandate, which congressional Republicans hope to repeal. One insurer has already invoked concerns about the mandate as a reason for exiting Iowas market.

Second, Republicans are playing chicken with Obamacare subsidies that are meant to help low-income people cover their out-of-pocket costs. Because insurers dont know whether the government will honor its commitment to pay those subsidies, theyve had to ask for double-digit rate increases.

Republicans appear not to have reckoned with the broader consequences of their uncertainty strategy. For example, Paul Ryan, the House speaker, wants to convert Medicare into a voucher program in which the elderly will shop for private plans. How will that work if insurers, burned by the Obamacare experience, are unwilling partners?

This is perhaps the greatest irony of the Republican actions. Republicans (including one of us) have long believed in the benefits of even greater privatization of government services. But how can any company in any sector trust the United States after seeing health insurers treated so shabbily?

Craig Garthwaite is an associate professor at the Kellogg School of Management at Northwestern University. Nicholas Bagley is a professor of law at the University of Michigan.

Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.

A version of this op-ed appears in print on June 29, 2017, on Page A21 of the New York edition with the headline: The Uncertainty Strategy.

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The Republicans' Uncertainty Strategy - New York Times

McConnell hopes to strike a deal on a revised version of the bill by Friday and send it to the Congressional Budget Office, according to The Washington Post. But resolving lingering differences could prove difficult in the short window.

Republicans face difficulties in winning over skeptical senators, as tweaks to appease conservatives could alienate moderates, or vice versa.The hurdles threaten to delay a key plank of the sweeping agenda Republicans hoped to pass when Trump won the White House and the GOP held onto both chambers of Congress.

Amid Republicans' push to win over skeptical senators, Trump set some lofty goals for the bill Wednesday.

"I think this has a chance to be a great health care at a reasonable cost. People can save a lot of money. We get rid of the mandates, we get rid of so much. Got rid of a lot of taxes. All the bad parts of Obamacare are gone. Essentially, it's a repeal and replace," Trump said.

A CBO score of the existing bill shows a mixed bag on those counts. It estimated that the bill would lead to 22 million more uninsured Americans by 2026 than under current law, a figure that multiple moderates criticized.

Average premiums would fall by about 20 percent relative to current law by 2026. But out-of-pocket costs could rise for many consumers "because nongroup insurance would pay for a smaller average share of benefits under this legislation," the CBO said.

The Senate plan would lead to an estimated $321 billion in deficit reduction from 2017 to 2026, according to the office.

The bill has received dismal approval ratings in polling so far. In addition, most major medical groups have opposed the proposal.

As Republican leaders pushed to strike a deal on the plan, some GOP senators increased their calls to figure out a bipartisan solution for Obamacare's problems. Sen. Lindsey Graham, R-S.C., told NBC News that if the GOP does not reach a deal by Friday, it may be time to start seeking a bipartisan solution.

Moderate Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, are among the other GOP senators who have said they would be open to a bipartisan solution.

On Tuesday, McConnell indicated that he did not see that as a possibility yet. He said of Democrats: "They're not interested in participating in this."

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Trump predicts a 'big surprise' on health care as Senate GOP pushes to win votes - CNBC

U.S. Senate Republican leaders postponed a vote on a healthcare overhaul on Tuesday after resistance from members of their own party, and President Donald Trump summoned Republican senators to the White House to urge them to break the impasse.

The delay put the future of a longtime top Republican priority in doubt amid concerns about the Senate bill from both moderate and conservative Republicans. With Democrats united in their opposition, Republicans can afford to lose only two votes among their own ranks in the Senate.

Senate Majority Leader Mitch McConnell had been pushing for a vote ahead of the July 4 recess that starts at the end of the week. The legislation would repeal major elements of Obamacare and shrink the Medicaid government healthcare program for the poor.

Were going to press on, McConnell said after announcing the delay, adding that leaders would keep working to make senators comfortable with the bill. Were optimistic were going to get to a result that is better than the status quo.

At the White House meeting with most of the 52 Republican senators, Trump said it was vital to reach agreement on the Senate healthcare measure because Obamacare was melting down.

So were going to talk and were going to see what we can do. Were getting very close, Trump told the senators. But he added, If we dont get it done, its just going to be something that were not going to like, and thats okay.

McConnell, whose party has a razor-thin majority in the 100-member Senate, told reporters that Republican leaders would work through the week to win over the 50 senators needed to pass the bill, with a vote planned after the recess. Vice President Mike Pence could provide the crucial vote needed to break a tie.

I think we can get 50 votes to yes by the end of the week, Republican Senator Roger Wicker said after the White House meeting.

Aaron Bernstein / Reuters

REPUBLICAN OPPOSITION GROWS

The House of Representatives last month passed its own version of a healthcare bill, but the Senate bill has been criticized from both the left and the right. Moderate Republicans worried millions of people would lose their insurance. Conservatives said the bill does not do enough to erase Obamacare.

The bills prospects were not helped by a Congressional Budget Office analysis on Monday saying it would cause 22 million Americans to lose insurance over the next decade, although it would reduce the federal deficit by $321 billion over that period.

The report prompted Senator Susan Collins, a Republican moderate, to say she could not support the bill as it stands. At least four conservative Republican senators said they were still opposed after the CBO analysis.

Three more Republicans, Rob Portman of Ohio, Jerry Moran of Kansas and Shelley Moore Capito of West Virginia, said after the delay was announced that they oppose the current draft.

Portman and Capito cited the bills Medicaid cutbacks and how that would hurt efforts to combat the opioid epidemic that has taken a heavy toll in their states. The Medicaid program was expanded under former President Barack Obamas signature healthcare law.

I think giving time to digest is a good thing, Republican Senator Bob Corker said after the delay was announced.

UNCERTAINTY ON WALL STREET

U.S. stock prices fell, as the decision to postpone the vote added to investor worries about Trumps ability to deliver on his promises of tax reform and deregulation, as well as changes to the health sector. Those expected changes have driven a rally in U.S. stocks this year.

The benchmark S&P 500 index closed down 0.8 percent, and the Dow Jones industrial average finished down 0.46 percent.

The market likes certainty and now theres uncertainty. What is this going to look like when this gets out of the next iteration? said Peter Costa, president of trading firm Empire Executions Inc.

Passing the measure would be a win for Trump as he seeks to shift attention after weeks of questions over Russias role in last years U.S. presidential election.

McConnell has promised since 2010 that Republicans, who view Obamacare as a costly government intrusion, would destroy the law root and branch if they controlled Congress and the White House. Republicans worry a failure to deliver will cost them votes in next years congressional elections.

If the Senate passes a healthcare bill, it will either have to be approved by the House or the two chambers would reconcile the differences in a conference committee. Otherwise, the House could pass a new version and send it back to the Senate.

Lawmakers are expected to leave town by Friday for their July 4 holiday break, which runs all next week. The Senate returns to work on July 10, the House on July 11. Lawmakers then have three weeks in session before their month-long August recess.

CORRECTION: An earlier version misstated how far down the Dow Jones industrial average finished on Tuesday.

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Facing Revolt On Healthcare Bill, Senate Republicans Delay Vote - HuffPost

WASHINGTON Unable to find enough support to advance their health care bill, Senate Republicans are delaying a vote on the proposal this week as they try to cut new deals that will bring conservative and moderate holdouts on board.

Senate Majority Leader Mitch McConnell (R-Ky.) was forced to put off the vote on Tuesday after a small but dedicated cross section of his GOP conference expressed discomfort with moving ahead. McConnell can only lose two Republicans in his 52-member conference, and Sen. Dean Heller (R-Nev.) and Susan Collins (R-Maine) have both strongly suggested they will vote against the bill. Sen. Mike Lee (R-Utah) has also announced his opposition, but leaders still consider him gettable, two senior GOP aides said.

Lee has teamed up with Sen. Ted Cruz (R-Texas) and Rand Paul (R-Ky.) in trashing the bill for not lowering premiums or repealing enough of the Affordable Care Act, otherwise known as Obamacare. With only two votes to lose, McConnell knows he needs all three to support the bill; otherwise, hes stuck trying to flip Heller or Collins not an impossible task, but an unlikely one, given their statements on the bill at this point.

The problem for McConnell is that Paul seems just as dedicated to opposing the bill, calling itterrible Monday night and saying it would be worse to pass a bad bill than no bill at all.

That opposition coupled with concerns from Sen. Ron Johnson (R-Wis.), who has expressed reservations about moving so fast, and from a number of other senators whose support for the legislation appears shaky at best forced McConnell to take more time to whip the bill and work out deals.

Every time you get one bullfrog in the wheelbarrow, another one jumps out, Senate GOP Whip John Cornyn (R-Texas) told reporters Tuesday.

McConnell met with one of those holdouts, Cruz, on Tuesday morning to discuss two proposals one that would allow insurers to offer plans that dont comply with Obamacare regulations, and another that would expand the use of health savings accounts.

That first proposal, which Cruz and other conservatives see as the path toward lower premiums, would effectively let insurers discriminate against people with pre-existing conditions and charge people more for services like maternity care. Its an amendment that moderates would almost certainly oppose.

But McConnell is hoping he can use some of the extra money that the Congressional Budget Office said his bill would save and put it toward a different amendment to shore up Medicaid slightly, after the CBO said the program would suffer a $772 billion cut over the next 10 years.

The bills Medicaid cuts alone are giving some senators more pause. Sen. Bill Cassidy (R-La.), who seemed to be on board with the legislation after months of opposition, is again sounding unsettled.

He told reporters on Tuesday that he wants more help for middle-income seniors who would face huge premium increases under the bill. (The CBO predicted that a 64-year-old making $56,800 who has a standard plan would see his or her premiums jump from $6,800 to $20,500.) And Cassidy said he had some specific concerns related to how the Medicaid expansion had affected his states baseline budget that he needs clarity on.

Cassidy wouldnt say how he would vote on a motion to proceed if McConnell were to schedule one.

But McConnell didnt schedule one. Instead, he announced that the Senate wouldnt take action, as promised, before the July Fourth recess.

Its an ongoing discussion, McConnell told reporters on Tuesday. And members want several of them want more time. We have a number of different discussions going on. Theyve been going on for 6 weeks now. They continue.

SAUL LOEB/AFP/Getty Images

After McConnell announced the delay, Republicans began immediately jockeying for a better negotiating position. Sen. Jerry Moran (R-Kan.) tweeted that the bill did not have his support and that he looked forward to taking a step back and letting the full legislative process work.

Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.V.) issued a joint statement opposing the bill because it didnt do enough to address the nations opioid epidemic. And Paul, who had met with President Donald Trump earlier in the day, tweeted that Trump was open to making the bill better. Is Senate leadership? he asked.

With McConnell unable to hit his own deadline, the Kentucky Republican was asked Tuesday if Trump would now be taking a larger role.

We always anticipated the president would be very important in getting us to a conclusion, McConnell answered. After all, under our system, hes the man with a signature.

But McConnell continued to say that engaging Trump in the early stages would have candidly, kind of been a waste of his time, and he said Republicans needed to get farther down the path so Trump could help close the deal. And were delaying the process so that we can close those remaining issues, he said.

With or without those remaining issues, Trump is clearly taking a larger role. After meeting with Paul, Trump dispatched his chief of staff, Reince Priebus, and his press secretary, Sean Spicer, to meet with Republicans. Vice President Mike Pence is also meeting with senators later Tuesday night.

And the hammer may soon be coming down, too. A pro-Trump super PAC has already been hitting Heller for his announced opposition, whileTrump has shown a willingness to knock Republican lawmakers on Twitter much like he did when the House version of the bill stalled.

That pressure could eventually motivate senators, particularly Republicans like Cruz who need the GOP bases support in the upcoming 2018 elections.

But it could also backfire.

Later in the afternoon, Trump hosted a group of Republican senators at the White House. Flanked by critics like Collins and Heller, Trump urged senators to repeal Obamacare, which he said was experiencing a meltdown. He claimed the conference was close to passing a bill, and asserted that Republicans had as many as 52 or 50 votes a characterization directly contradicted by the decision to delay the vote this week, and by common sense.

If we dont get it done, its just going to be something that were not going to like and thats OK, the president added.

Trump appears to have little handle on the policy or political situation, and hes trying to convince senators to take a leap of faith when most evidence suggests its not in the interests of many states or voters to pass this legislation.

Thats particularly true in Alaska, where Sen. Lisa Murkowski (R) continues to sit on the fence.

Joshua Roberts/Reuters

Murkowski has very specific concerns about how Alaska would be affected by the bill, and she isnt up for re-election until 2022. Trying to pressure her into voting for the health care plan isnt likely to work not when she has such specific and major issues. And forcing her to draw a line on the bill or against Trump may end up sinking the legislation.

One easy fault line would be Planned Parenthood funding. Murkowski is already working with Collins on crafting an amendment that would restore funding for Planned Parenthood, which the GOP bill would cut off for one year. Forcing her to make her support conditional on that amendment would likely either cost Republicans her support, or cost the support of a handful of conservatives. The same could be said of protections for people with pre-existing conditions, which Murkowski wants to keep and conservatives want to gut.

And again, that is McConnells struggle. Every concession he accepts from moderates could imperil the support of conservatives, and vice-versa. Ultimately, one or both sides of the conference will be unhappy with the legislation, and McConnell (with the help of Trump, perhaps) will have to convince Republicans to just accept the compromise.

As for the delay, hardly anyone took it to mean the bill was dead. House GOP leadership already showed how quickly these proposals can come back to life and how delays can even be useful. Part of the reason House Republicans were successful in passing their bill was that opposition cooled the month after House Speaker Paul Ryan (R-Wis.) called off a vote, with Democrats blindsided that moderates and conservatives had actually struck a deal.

In that spirit, Senate Democrats stopped short of taking a victory lap on Tuesday after the delay was announced. Instead, they continued rallies on the Capitol steps, holding up photos of constituents who would be adversely affected by the GOP proposal.

Were going to fight this bill tooth and nail, and we have a darned good chance of defeating it, Senate Minority Leader Chuck Schumer (D-N.Y.) said. The Republicans cannot excise the rotten core at the center of their health care bill.

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Senate Republicans May Be Down On Health Care, But They're Not Out - HuffPost