WASHINGTON — The dispute within the Republican Party over health care widened further Friday as President Trump joined with two conservative senators in calling for an outright repeal of the Affordable Care Act if the party fails to agree on an alternative plan by the end of the July Fourth recess.

The re-emergence of what has for much of the year been a fringe idea within the party revealed not only its philosophical divide over how to revise Obamacare, but also senators’ growing anxiety that they are headed home to see their constituents with little to show them.

Sen. Bill Cassidy, R-La., – who has said he cannot yet support the current draft of the Senate bill, because of the effects its cuts in Medicaid funding would have on his state – received a blistering reception at a Baton Rouge, Louisiana, town hall Friday. As he sought to discuss flooding issues, an attendee interrupted to mention Medicaid, prompting others to chant, “Health care! Health care!”

“If you wish to chant and stop others from being able to speak or be heard, that is not civil,” Cassidy retorted.

Senate Majority Leader Mitch McConnell, R-Ky., rejected Trump’s suggestion and continued to work on forging a compromise that could garner sufficient support once his colleagues return to Washington on July 10.

Trump’s suggestion, in fact, could make it harder for McConnell to broker a deal.

An early-morning tweet was Trump’s first public statement since taking office in favor of bringing down Obamacare with no replacement system in place – a move that could send the U.S. health care system into deep turmoil.

“If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!” Trump tweeted.

Health industry officials have warned that overturning the existing law, which has extended insurance to roughly 20 million Americans and changed the rules under which insurance is offered across the country, would create chaos in a sector that accounts for one-sixth of the U.S. economy.

Robert Laszewski, president of Health Policy and Strategy Associates, said repealing the ACA without a replacement would be “a trauma” for an insurance market that needs regulatory clarity to set premium rates.

“There would be absolutely no certainty, whatsoever, about anything,” Laszewski said.


A June 2015 Congressional Budget Office analysis projected that such an outright repeal would add $137 billion to the federal deficit between 2016 and 2025 and leave 24 million non-elderly adults without health coverage between 2021 and 2025.

Two Republican senators who espouse this approach, Rand Paul of Kentucky and Ben Sasse of Nebraska, welcomed Trump’s suggestion. But some of the high-ranking Republicans who have been working on the legislation rejected it as impractical, noting that it might force them to fashion a substitute with Democrats.

An even larger group of Senate Republicans suggested Friday that McConnell should scale back or cancel the chamber’s monthlong August recess, given the lack of progress they have made not just on health care but a tax-code overhaul, spending bills, the debt ceiling and a budget resolution.

Senate Republicans David Perdue of Georgia, Steve Daines of Montana, Joni Ernst of Iowa, John Neely Kennedy of Louisiana, James Lankford of Oklahoma, Mike Lee of Utah, Mike Rounds of South Dakota, Luther Strange of Alabama, Dan Sullivan of Alaska, and Thom Tillis of North Carolina sent McConnell a letter Friday asking him to shorten or cancel the August recess so they can get more done.

“Delivering meaningful results was never assumed to be easy, but the millions of Americans who placed their confidence in our leadership expect our full and best effort,” the 10 senators wrote.

Republicans are steeling themselves for attacks on their health care negotiations over the July Fourth recess, with progressive activists planning to pressure any members of Congress they see at public events. Most Republican senators were keeping their plans close to their vests, though a handful, including Maine’s Susan Collins, Cassidy, Ted Cruz of Texas, Jerry Moran of Kansas and Lisa Murkowski of Alaska have announced town halls or parade visits.

Collins, a vocal critic of the current Senate draft, had publicized just one scheduled appearance – in Eastport, Maine.

At Cassidy’s town hall at the Living Faith Christian Center in Baton Rouge, he tried to make the case for transitioning Medicaid recipients into private insurance. But constituents interrupted him repeatedly, prompting him to chastise them for being rude.

“I’ll tell you what’s rude – kicking 22 million people off of health care in this country,” said a man in the front row after the senator recognized him to speak.

The audience erupted into cheers.

Reminding Cassidy, a medical doctor, of his stint treating patients at a hospital for the uninsured, the man continued: “You worked at Earl K. Long for many years. You know what people are like at their lowest.”

Senate Democrats are staging events aimed at highlighting how the Senate’s draft bill could hurt health care delivery in their home states. Sen. Heidi Heitkamp of North Dakota is visiting at least two rural hospitals over the break to underscore the impact of proposed funding cuts.


McConnell is trying to tweak his original proposal, which would make deep cuts in Medicaid while providing tax cuts to companies and wealthy Americans. The changes are part of an effort to bring on a handful of conservative and centrist senators who have questioned parts of the bill.

While it is unclear what specifically prompted Trump’s tweet, an aide to Sasse said that the senator had discussed the idea of a straight repeal privately with White House officials in recent days. On Friday, Sasse released a letter to the president suggesting that if an agreement is not reached by the day that members return from their weeklong recess, the president should call on Congress to repeal the ACA and work through August to craft a replacement by Labor Day.

Paul, who retweeted Trump on Friday morning, later fired off a second tweet saying he had spoken to Trump and Senate Republican leadership “about this and agree. Let’s keep our word to repeal then work on replacing right away.”

And Americans for Prosperity’s chief government-affairs officer, Brent Gardner, whose conservative group is funded by Charles and David Koch, said the approach “has real merit.”

Deputy White House press secretary Sarah Huckabee Sanders said Trump did not see July 10 as a deadline to pass legislation. She added: “We’re still fully committed to pushing through with the Senate, at this point, but we’re, you know, looking at every possible option of repealing and replacing Obamacare. We are focused on doing that.”

Asked for the majority leader’s response to Trump’s Friday tweet, a McConnell spokeswoman said she did not have any new announcements.

Senate Republicans, along with their House counterparts, have repeatedly voted to abolish Obamacare without putting anything in its place, including as recently as 2015. In that Senate vote, only two Republicans dissented: Collins and Mark Kirk of Illinois, who lost his reelection bid last year.


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