WASHINGTON -- Republicans are at risk of facing voters this year with no cohesive strategy to fulfill their seven-year campaign promise to repeal and replace the 2010 health care law or address the rising cost of health care.
Following a meeting at Camp David over the weekend between President Donald Trump and top congressional leaders, members said a major overhaul of the law is unlikely this year.
Such a move could anger members of the GOP base, who have heard Republicans pledge for years to gut the law, as well as a broader set of voters whom Democratic political operatives say are opposed to the failed Republican health care proposals from last year.
Senate Republicans say instead they would attempt to move smaller, bipartisan bills intended to help stabilize the insurance markets. But even that will be difficult. Democrats say GOP attempts to undermine the law have done significant harm and are now calling for more robust measures that would likely face stiff resistance from conservatives.
Republicans have one major accomplishment they can tout: repealing the tax penalty for not purchasing health insurance. But experts, as well as the Congressional Budget Office, say removing the individual mandate without any sort of replacement policy could destabilize the markets and spike premiums.
Some Senate Republicans say that by zeroing out the penalty -- a provision included in the GOP tax overhaul -- the party now owns the health care system and will suffer the consequences of increased premiums.
"I think it's a real problem for us," South Carolina Sen. Lindsey Graham said. "Obamacare is still the law of the land. To think that you can just not replace it after promising to do so for many, many years is pretty naive. The system's gonna collapse and now we own it."
Unlike the House, Senate Republicans were unable to coalesce around a single health care proposal and failed to garner the votes necessary to advance a measure.
While some pockets of the GOP would prefer to try again on a major health care overhaul, the effort would be more difficult this year with a reduced Republican majority in the chamber.
And the motivation for another attempt at what many members described as a painful effort appears to be lacking.
"The fact that we were only able to get 49 of 52 to support a proposal indicates there's still some disagreement," said Ohio Republican Rob Portman, referring to the vote count for the bill that failed last summer.
Key GOP swing votes, such as Sen. Lisa Murkowski of Alaska, say they would prefer to see the effect of the mandate repeal before a broader overhaul. Senate Majority Leader Mitch McConnell has also been pessimistic that any major health care overhaul could happen in 2018.
"Well, we obviously were unable to completely repeal and replace with a 52-48 Senate," the Kentucky Republican told NPR in December. "We'll have to take a look at what that looks like with a 51-49 Senate. But I think we'll probably move on to other issues."
Those comments do not appear to sit well with conservatives, who are ramping up pressure on Hill Republicans to tackle health care again this year.
"Americans need relief, and we believe they will hold their representatives accountable at the polls this November," representatives from 10 groups, along with former Pennsylvania GOP Sen. Rick Santorum, wrote in a recent letter to Trump and congressional leaders. "Health costs are rising faster than before, and there's no real prospect of a reversal without legislative action."
The letter cited a recent poll conducted by the Associated Press-NORC Center for Public Affairs Research, which found that health care remains a top issue for both Democrats and Republicans.
Senate Republicans might have an easier cycle than their Democratic counterparts in 2018. Only five GOP members are facing re-election this year, while three are retiring. But Alabama Democrat Doug Jones' arrival reduced the Republican majority to 51-49, and the minority party is more optimistic that control of the Senate is up for grabs.
"It's very clear what we want out of the health care system. It's something that actually results in lower prices, better quality of care. And we made that clear throughout the debate last summer and we're going to continue to make that clear," said Colorado Sen. Cory Gardner, the chairman of the National Republican Senatorial Committee.
Democratic political operatives say the proposals the GOP has presented to date will harm the party in the midterms.
"The problem for Republicans is that voters got a taste of their 'strategy' all year: higher health care premiums, an age tax and jeopardizing coverage for preexisting conditions. The GOP has worked to sabotage health care at every turn and that's why hardworking Americans will hold them accountable in November," said David Bergstein, a spokesman for the Democratic Senatorial Campaign Committee.
Apart from voters, the GOP could also face pressure from the White House to act.
Trump "remains committed to providing the American people with affordable healthcare, including relief from the onerous mandates and taxes of the catastrophic Obamacare law," Deputy White House Press Secretary Hogan Gidley said in a statement.
Republican senators say they hope to advance two bipartisan proposals this year to help bring some relief to Americans in advance of the 2018 elections.
One from Senate Health, Education, Labor and Pensions Chairman Lamar Alexander and ranking member Patty Murray would give states greater flexibility to implement aspects of the law.
But while that measure enjoyed strong bipartisan support last year, it could face more difficult prospects this year with Democrats now demanding changes to the legislation.
"There's not a way for the language that we agreed on to deal with the marketplace that has changed," Murray said.
Senators are hoping to attach the Alexander-Murray measure, as well as a separate bill from Maine Republican Susan Collins and Florida Democrat Bill Nelson, to a fiscal 2018 spending bill.
"There was a commitment to do that by the president. Sen. McConnell's made that commitment, so that's our hope," Senate Majority Whip John Cornyn of Texas said.
But discussions on health care continue to be overshadowed by several other issues, including the debate over the pending expiration of the Deferred Action for Childhood Arrivals program, funding the government past Jan. 19, and addressing the debt ceiling.
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