The Senate Republican healthcare bill is dead, and it doesn't look like it'll come back

The Republican effort to repeal and replace Obamacare in one fell swoop appears to have crumbled Monday, and another revival doesn't appear likely.

Republican Sens. Jerry Moran and Mike Lee announced they would oppose a key procedural step to bring the Senate GOP bill, the Better Care Reconciliation Act (BCRA), to the floor for debate. The two new defectors joined GOP Sens. Susan Collins and Rand Paul in opposing the motion.

Republicans would need 50 votes - no more than two defections - to move the bill forward.

Politico reported that President Donald Trump was in the midst of a strategy dinner with other GOP members on the bill when Lee and Moran announced their intention to oppose it, blindsiding the White House.

Immediately after the Lee and Moran announcement, other Republicans called for the conference to abandon the current track and work on a bipartisan approach.

Senate Majority Leader Mitch McConnell now is left scrambling to attempt a repeal-only, replace-later strategy, which could be popular with conservative-leaning members but lose the more moderate side of the conference.

Experts and analysts say any more forward momentum on a GOP healthcare bill is dead for now. So one of the biggest Republican promises of the past seven years will likely remain unfulfilled, at least through next year's midterm elections.

Wheels fall off

Moran and Lee served as nails in the coffin for the BCRA, which already faced an uncertain future after multiple revisions and a rash of defections.

McConnell found himself stuck as the BCRA faced resistance from both ends of the Republican conference. Moderates didn't like its cuts to Medicaid and projections of large coverage losses. Conservatives were frustrated that the regulatory structure and taxes from Obamacare that were left in place.

Cobbling together a workable compromise became nearly impossible, since any attempt to win over one side invariably left the other less likely to jump on board.

Given the cover provided by Moran and Lee, it is possible that even more Republican senators will come out against the BCRA and any other healthcare efforts in the coming days, said Chris Krueger, an analyst at the Cowen Washington Research Group.

"We would be shocked if four was the floor for GOP defections," Krueger wrote in a note Tuesday. "The Rubicon was crossed and we suspect a number of other Senate Republicans will begin the bail. Watch McConnell and the Trump Twitter Machine."

Appetite for 'repeal only'

The BCRA's failure has pushed McConnell to move toward a bold back-up plan: a vote on a repeal-only bill that gives the Senate two years to come up with a replacement - if Republicans vote to proceed to debate on the BCRA.

Since the process is going through budget reconciliation, only certain aspects of the Affordable Care Act could be repealed. But they are some of the most important: Funding for tax credits to buy insurance, the individual mandate to purchase insurance, and funding for the Medicaid expansion could all be stripped out under this scenario.

A similar idea taken up by the House was scored by the Congressional Budget Office in 2015 and found that 32 million more people would go without insurance by 2026 than the current system if there was no replacement put into effect. That is above the 22 million and 23 million more uninsured that the CBO projected for the Senate and House replacement bills, respectively.

Given the massive projected coverage losses, it's unclear whether the more moderate-leaning wing of the party would sign on to such a plan. Conservatives could also be put off by the trade-off in voting to move forward for consideration of the BCRA.

Greg Valliere, chief strategist and long-time political analyst at Horizon Investments, said it probably isn't going to happen.

"Mitch McConnell probably will not succeed with his Plan B - a repeal of Obamacare, taking effect in two years," Valliere wrote in a note to clients on Tuesday. "Theoretically a replacement bill could pass during that period, but if the Republicans couldn't agree on a replacement for the past seven years, what makes anyone think they can do it in the next two?"

McConnell could pressure holdouts by telling them they voted for the same measure in 2015, which was ultimately vetoed by President Barack Obama. But that would still be unlikely to sway recalcitrant members.

"The difference between 2015 and now is that Republicans are shooting with real bullets," one GOP strategist told Business Insider before Monday's developments. "When you're doing that these senators want to make sure there aren't big coverage losses in their states and they're not hurting constituents."