Republicans' ACA repeal effort on uncertain ground as Congress returns from recess

Senate Republicans are returning from recess with their healthcare bill still on shaky ground.

Senate Republicans returned from the Fourth of July recess no closer to a repeal of the Affordable Care Act, with some prominent GOP senators calling the bill “dead.”

Ten senators so far have openly defected from the current draft of the Better Care Reconciliation Act, with three others withholding support but not standing against the bill, The New York Times reported. This leaves Senate Majority Leader Mitch McConnell, R-Ky., with the task of uniting warring factions in the party in the short window before the monthlong August recess.

Sen. Bill Cassidy, R-La., said that the current draft of the BCRA is “dead,” though there may still be some life in efforts to rewrite the bill. Sen. John McCain, R-Ariz., echoed the sentiment, saying it may be time for Republicans to work with Democrats for a bipartisan healthcare solution, according to an article from the Associated Press.

RELATED: If Senate healthcare bill fails, Republicans may have to repair ACA exchanges, McConnell says

The defectors are a mix of hard-line conservatives who want a repeal bill to do even more to dismantle the ACA and more moderate senators who want to preserve Medicaid expansions and other funding cuts to programs that primarily benefit low-income people. Sen. Shelley Moore Capito, R-W.Va., is one of the loudest GOP voices opposing the bill, as 30% of people in her state rely on Medicaid, she told Politico.

“I only see it through the lens of a vulnerable population who needs help, who I care about very deeply,” Capito said. “So that gives me strength. If I have to be that one person, I will be it.”

The Congressional Budget Office estimated that the current draft of the BCRA would cause 22 million people to lose their insurance coverage, and would lead to a 35% federal spending cut to Medicaid by 2036.

The more conservative wing of the party is also pushing its own changes. Sen. Ted Cruz, R-Texas, is promoting a conservative amendment to the bill that would allow insurers to offer non-ACA compliant plans in any state they also offer plans that meet the ACA’s rules. This plan is likely to alienate moderates, and McConnell can only afford to lose two Republican votes to pass a bill through reconciliation.

Sen. Chuck Grassley, R-Iowa, also noted on Twitter the impact that a failed effort could have on the party’s Senate majority:

Despite uncertainty in the Senate, the White House is staying firm on the need for a repeal. President Donald Trump’s Chief of Staff Reince Priebus said over the weekend that failure is unacceptable, according to Politico.

“The president expects them to get this done,” Priebus said. “The president expects the Senate to fulfill the promises it made to the American people.”

Trump also took to Twitter to address the issue himself:

The Senate’s bill is wildly unpopular among healthcare industry groups and the public. A new poll from National Public Radio, Marist and PBS Newshour found that just 17% of Americans support the BCRA, and a majority now approve of the ACA.