At least one Republican senator predicted a consensus was still several more weeks away, and few senators have been willing to defend the bill publicly

Republican senators left Washington more than a week ago without voting time a long-promised repeal of the Affordable Care Act or their unpopular plan to replace it. The GOP lawmakers return on Monday with the daunting task of crafting a bill still very much in front of them, amid swirling doubts concerning the prospect of finding a solution any time soon.

My view is its probably going to be dead, Arizona senator John McCain told CBS on Sunday. I fear that its going to fail.

A vote is unlikely to take place this week, with at the least one Republican senator predicting that his colleagues are still several more weeks away from reaching a consensus on a healthcare replacement. Last week at a town hall, Senate majority leader Mitch McConnell compared the process of negotiating healthcare reform with intransigent Republican senators to solving a Rubiks cube.

Im in the position of a guy with a Rubiks cube, trying to spin the dial in such a way to get at least 50 each member of my conference who can agree to a version of repealing and replacing Obamacare, McConnell said. That is a very timely subject that Im grappling with as we speak.

Republicans were not meant to still be grappling with healthcare over the Fourth of July recess. When Trump took office and the GOP kept control of Congress, they laid out an ambitious agenda that included repealing Obamacare as early as January and then moving on to taxation reform and infrastructure.

But intransigent Republican opposition and a groundswell of political activism following the completion of Trumps election derailed that timeline. Now its summertime and with merely a handful of running weeks left before the August recess, the Senate Republican leadership is still searching furiously for 50 votes, a tally that would only push them over the finishing line with a casting vote from the vicepresident, Mike Pence.

The clearest sign of Republican resistance to the bill was how few senators were willing to defend the bill publicly. During the Fourth of July recess politicians typically relish the opportunity to march in patriotic parades and clasp hands with constituents. But this year those appearances were scarce.

And the few Republican senators who made public appearances were met with protests and pleas from constituents concerned about the Republican healthcare plan.

Susan
Susan Collins. Photograph: J Scott Applewhite/ AP

At a parade in Eastport, Maine, Susan Collins, whose opposition to an initial draft of the healthcare law helped delay the vote, said her constituents were singularly focused on healthcare.

There was only one issue. Thats unusual. Its usually a wide range of issues, Collins told the Washington Post. I heard, over and over again, encouragement for my stand against the present version of the Senate and House healthcare bills. People were thanking me, over and over again. Thank you, Susan! Stay strong, Susan!

Where a Republican senator refused to hold a town hall, voters stimulated their views known. Tens of thousands of liberal activists and concerned constituents turned out for dozens of rallies across the country to recommend their senators to vote no on the healthcare bill. Some groups coordinated protests and staged sit-ins at senators offices, and in Columbus, Rob Portmans constituents held a cookout.

As initially drafted, the Republican healthcare plan would repeal major pieces of the ACA, including the mandate that all Americans buy health insurance or face a penalty. It would also build deep cuts to Medicaid, a joint state-federal public health program for low-income Americans, compared with spending under the current law.

An analysis by the nonpartisan Congressional Budget Office( CBO) estimated that 22 million people would lose healthcare over the next decade for the purposes of the Republican healthcare plan. In a new report that assessed the plans impact over two decades, the agency estimated that spending on Medicaid under the replacement scheme would be 35% lower by 2036 than under current law.

McConnell has introduced a number of changes, including adding $45 bn to combat the opioid outbreak. Also under consideration is a compromise amendment by Ted Cruz, the conservative Texas senator who opposed the bill because it did not go far enough in repealing Obamacare.

Under the Cruz proposal, insurance companies could sell non-AC-Acompliant healthcare plans as long as they also offered at least one that fulfilled the laws mandates, including coverage for maternity care, mental health treatment and prescription drugs. Though the proposal is gaining traction among conservatives, healthcare experts on both sides of the political debate believe the measure would likely result in prohibitively high costs for comprehensive schemes, which sicker Americans would need.

McConnell sent an update, including the Cruz amendment, of the healthcare plan to the agency, and a new report is expected this week. The CBO is expected to release another analysis sometime next week, a likely indicator that Senate Republican will not vote on the scheme until later this month.

I think we are making steady progress, Cruz told ABC on Sunday. The conversations have been coordinated and in good faith.

If Republicans fail to reach an agreement on a replacing scheme, McConnell said he would work with Democrats to stabilize the insurance markets.

No action is not an alternative, McConnell told constituents at a Rotary Club lunch on Thursday, in agreement with the Associated Press. Weve got the insurance markets imploding all over the country, including in this state.

But Cruz said he agreed with a proposal by Trump seen as unhelpful and unrealistic by many Republican that the GOP should try to repeal Obamacare without concurring a replacing if the Senate bill fails.

If we cant get this done right now, I agree with the president, then lets honor the promise on repeal and expend more time to get it done, Cruz said on Sunday.

I believe we can get it done.

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