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US Republicans, facing health care revolt, delay Senate vote
[WASHINGTON] US Republicans eager to repeal "Obamacare" suffered a deeply embarrassing setback Tuesday when shrinking support forced them to postpone votes on their controversial health care overhaul, one of President Donald Trump's top priorities.
With the Senate bill delayed by a few weeks and maybe more, the timeline of the effort - and the overall viability of a years-long bid to dismantle Barack Obama's Affordable Care Act in favour of a Republican replacement - was thrown into question.
Senate Majority Leader Mitch McConnell acknowledged he simply did not have the votes, after a grim, non-partisan forecast projected the bill would leave 22 million fewer people insured by 2026, as compared to current law.
Mr McConnell said party members would "continue the discussions within our conference on the differences" that they have.
"Consequently, we will not be on the bill this week, but we're still working toward getting at least 50 people in a comfortable place."
The ideological differences between conservatives and moderates were so stark that it became clear that leadership did not even have the 50 votes in the 100-member chamber needed to simply begin debate on the bill.
"It's an ongoing discussion, and several of them want more time," Mr McConnell said.
But he insisted the bill was far from dead. After the announcement, Republican senators trooped down to the White House for a special meeting with Mr Trump, who Mr McConnell said has been "fully engaged" in the process.
The gathering is reminiscent of the health care effort in the House, when Mr Trump hosted Republican congressmen after Speaker Paul Ryan was forced to pull the first version of the House bill - presumably to apply pressure.
A tweaked version then passed the House, with a handful of Republicans opposing it.
The Senate delay is nevertheless a huge blow to Trump and Republican lawmakers who have spent the last seven years plotting an end to the Affordable Care Act, commonly known as Obamacare.
It also highlights the deep ideological divides within the party over how to improve the health care system while not cutting millions of Americans out of insurance coverage.
The Senate draft would allow states to drop several benefits which are now mandated, such as maternity care and hospital services, and also would abolish the requirement for most Americans to have health insurance.
But it also would delay cuts to the Medicaid programme and initially maintain the tax credits included in the Affordable Care Act to help lower-income Americans purchase coverage.
Conservatives say the Senate bill does not go far enough, and would still put too heavy a burden on government coffers. Moderates say they can't vote for a bill that would see the number of uninsured Americans balloon to pre-Obamacare levels.
"It's the biggest signature issue we have. And it's the biggest promise we've ever made in the modern era," House Speaker Paul Ryan said Tuesday on Fox News, before the collapse in the Senate.
"We said if we get elected, we will repeal and replace Obamacare. We did this in the House. It is now the Senate's turn and I think they're going to do it."
Republicans hold 52 Senate seats. They need at least 50 votes for passage, as Vice-President Mike Pence would break the tie in favour of the measure. At least five Republicans senators have said they would vote no on the bill as it is.
Top Senate Democrat Chuck Schumer said Americans would be better off if lawmakers jettisoned the Republican bill and sat down together in a bipartisan effort to improve Obamacare.
"No matter how the bill changes around the edges, it is fundamentally flawed at the center," he said.
Warning that "the fight is not over," Mr Schumer accused Mr McConnell of preparing to dangle plum projects for states where senators are on the fence about the bill to "buy off Republicans (and) use backroom deals to get this thing done."
Who would be affected?
America's health care system is a labyrinth of public and private structures, operating at the federal, state and local levels.
The Republican reform plan would not directly affect half of Americans, who receive health insurance through their employers. It also would not affect those 65 and older who are eligible for government benefits under Medicare.
It would however cut deeply into Medicaid, America's public health programme for the poor and disabled. Medicaid costs are rising at a fast and ultimately unsustainable rate, critics say.
Republicans want to gradually cap Medicaid expenditure - which would mean 15 million people would lose their benefits by 2026, according to a report by the non-partisan Congressional Budget Office.
CBO estimates that seven million people who buy individual insurance would lose coverage over the next decade, as compared to current law.