The future of the Republicans' health care bill is once again in peril this week after Sen. John McCain underwent surgery for a blood clot and announced he would not be able to return to Washington to vote on legislation to overhaul Obamacare.
Senate Majority Leader Mitch McConnell announced Saturday night that GOP leaders plan to "defer" consideration of the health care bill, which was expected to take center stage this week.
The delay allows more time for Republicans to review the bill, first unveiled last Thursday. But there's no guarantee the extra time will accomplish anything except giving senators more heartburn.
Even before McCain's absence, McConnell faced a daunting path to passing the GOP's Better Care Act. The majority leader needs to secure 50 votes to advance the bill and already had two members -- Sens. Rand Paul of Kentucky and Susan Collins of Maine -- vowing to vote against the legislation. McConnell can't afford to lose one more Republican senator or the GOP's seven-year campaign promise to repeal and replace Obamacare is over -- for now, at least.
The delay keeps Washington at a standstill, as health care is the only pillar of President Donald Trump's agenda that has had any real momentum in Congress, having passed the House in May. So far, White House sales pitches haven't converted skeptical senators to publicly support the bill.
Trump continues to tweet and senior administration officials with policy knowledge have been meeting with lawmakers. But they may not like what they see. Trump continues to have record-low approval ratings and Connecticut Democratic Gov. Dan Malloy blasted Vice President Mike Pence's weekend outreach to governors as "pretty atrocious."
Meanwhile, the latest Congressional Budget Office report on the bill -- and likely negative headlines for the White House and GOP about people who could lose health care under their plan -- won't be released Monday as previously planned.
Senate Majority Whip John Cornyn, R-Texas, indicated there would not be a long delay.
"I believe as soon as we have a full contingent of senators, that we'll have that vote," Cornyn said on NBC's "Meet the Press" Sunday.
Attacks from moderates and conservatives
According to CNN's whip list, there are still more than a dozen GOP members undecided on whether they will vote to advance the bill, and throughout the weekend, lawmakers continued to voice their concerns.
"This bill would impose fundamental, sweeping changes in the Medicaid program," Collins said on CNN's "State of the Union" Sunday. "Those include very deep cuts that would affect some of the most vulnerable people in our society, including disabled children, poor seniors. It would affect our rural hospitals and our nursing homes."
Paul continued to attack the bill as well.
"I think the longer the bill's out there, the more conservative Republicans are going to discover that it's not repeal," he said on CBS's "Face the Nation. "And the more that everybody's going to discover that it keeps the fundamental flaw of Obamacare. It keeps the insurance mandates that cause the prices to rise, which chase young, healthy people out of the marketplace, and leads to what people call adverse selection, where you have a sicker and sicker insurance pool and the premiums keep rising through the roof."
Pence and top Medicare and Medicaid administrator Seema Verma were deployed to Rhode Island over the weekend to meet with skeptical governors at the National Governors Association's summer meeting. In private meetings, Pence and Verma tried to convince governors that the GOP's health care bill would give them greater flexibility to design Medicaid programs that were better tailored to their needs.
But the weekend didn't go especially well for the administration. After a speech in which Pence claimed 60,000 disabled Ohioans were waiting to get care, a spokesman for Ohio Republican Gov. John Kasich dismissed the claim as false on Twitter.
Malloy described Pence's private meeting with the governors Saturday as "pretty atrocious" as Pence encouraged governors to dismiss an unfavorable score from the Congressional Budget Office that showed 15 million Americans would lose Medicaid coverage over the next decade.
It was unclear whether key governors like Republican Brian Sandoval of Nevada left the meeting any closer to backing the Senate's health care bill. A key Senate vote -- Nevada's Dean Heller -- has tied his support to Sandoval's.
How to win over votes
Back in Washington with an extra week to look at the legislation, Republican senators are expected to continue deliberating with their governors and state Medicaid offices about how the GOP's health care bill will affect their states.
The biggest obstacle for McConnell is winning back the Senate's moderate Republicans.
Going into this week, Sens. Heller, Rob Portman of Ohio, Shelley Moore Capito of West Virginia, and Lisa Murkowski of Alaska all remain undecided on whether they will eventually vote to advance the bill. All of them have expressed initial concerns about how the Republican health care bill -- which would make significant cuts to Medicaid -- would affect low-income people in their states.
"Well, I'm gonna take a look at the bill. We'll read it over the weekend and come up with a decision and see if there's any improvements," Heller told reporters as he left the Capitol Thursday. "They'll be a lot of meetings and it'll include discussions with the governor, also."
For Portman and Heller, getting to "yes" remains even tougher as both of their governors continue to publicly express concerns with the latest version of the health care legislation.
Another potential stumbling block remains Texas Sen. Ted Cruz's amendment. The plan was included in the health care bill to give insurers more flexibility in the plans they can offer and as a way to try and entice conservatives to support the measure.
However, on Friday night, the CEO's of America's Health Insurance Plans and the BlueCross BlueShield Association called the plan "unworkable," and the conservative plan isn't going to easily get moderates on board.
The groups wrote in a letter to McConnell and Democratic Minority Leader Chuck Schumer that the amendment "would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market."
There are also questions about whether the Congressional Budget Office will have time to score the amendment before a vote and whether it will meet the arcane rules of budget reconciliation.
Negotiations aren't over -- especially now that leadership has additional time to try and convince individual senators to back the bill.
It's expected that by keeping some of the taxes for the wealthy, leadership may have more money to dole out in upcoming days as they try to make a deal.