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GOP was thwarted by its own moderates

US Senator Susan Collins, Republican of Maine, has been a center of attention during the deliberations about the health care bill.Andrew Harnik/Associated Press

WASHINGTON — Considered a dying breed in Washington, Republican moderates delivered stunning defeats to attempts by the White House and Senate majority leader Mitch McConnell to repeal the Affordable Care Act, culminating in an emphatic rejection Tuesday that essentially killed the effort.

GOP centrists, especially Senator Susan Collins of Maine, dug in hard against Medicaid cuts contained in the Senate bill to repeal the health law over the past several weeks. On Tuesday, Collins joined two other centrist Republican women — Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska — to stifle McConnell’s last-ditch attempt: a plan to vote on a repeal bill, followed by a yet-to-be-written replacement for the ACA in two years.

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Capito, Collins, and Murkowski spelled out their opposition to McConnell’s new strategy in blunt terms, rejecting his call to vote on a repeal bill that the Congressional Budget Office said would leave 32 million more Americans uninsured than current law. All three women were excluded from the small working group that McConnell had assembled to draft an earlier Senate repeal-and-replace bill, though Capito later attended several meetings of that group.

The centrists’ stand foiled the Republicans’ best chance to make good on seven years of promises to repeal former president Obama’s signature accomplishment. Instead, both Collins and Murkowski said they wanted leaders to start working with Democrats on a bipartisan fix for the problems that ail the current system.

“I did not come to Washington to hurt people,” said Capito, who represents a state where two out of every three voters backed Trump in November. She noted that she’s had concerns “for months” about how to protect constituents who benefited from her state’s decision to expand Medicaid under the current law, particularly in light of the state’s opioid epidemic.

“We can’t just hope that we will pass a replacement within the next two years,” said Collins, the only one of the three who voted against a repeal bill when Republicans passed it in 2015. “Repealing without a replacement would create great uncertainty for individuals who rely on the ACA and cause further turmoil in the insurance markets.”

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Murkowski told reporters that repealing the health care law without a replacement plan “just creates more chaos and confusion.”

The GOP humiliation at the hands of a small minority of senators could be an ominous sign for legislative battles to come, as Republican leaders sift through their defeats and seek progress on other planks of Trump’s agenda, from tax cuts for big business and high earners to a big transportation and public works spending package.

As with health care, Trump and his administration haven’t shown strong leadership on either the substance or the marketing of these other thorny policy matters.

“If you don’t know where the president is, it’s really hard for 535 members to legislate. They need some path forward with some political cover if they’re going to take tough votes,” said Sarah Binder, a congressional expert with the Brookings Institution, pointing to Trump’s widely-reported private comments calling the House health care bill “mean” after he celebrated its passage with a Rose Garden press conference.

From left: Senators Shelley Moore Capito, Tim Scott, and Deb Fischer left Majority Whip John Cornyn's office Tuesday.Chip Somodevilla/Getty Images

Trump responded to the latest series of setbacks with finger-pointing and blame-shifting. “We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard,” he tweeted early Tuesday morning before the opposition to McConnell’s repeal-only maneuver materialized.

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Later, he told reporters, “I’m certainly disappointed. For 7 years, I’ve been hearing ‘Repeal and replace’ from Congress, I’ve been hearing it loud and strong and when we finally get a chance to repeal and replace, they don’t take advantage of it.”

McConnell was more politic. “This has been a very, very challenging process,” he said. He indicated he’d defer to the relevant committee chairmen to tackle the issue. “We’ll have to see what the way forward is.”

For Collins, more than the other rebels, the health care debate has turned into a legacy-defining moment. The four-term senator has consistently been at the forefront of those raising concerns about the thrust of the Obamacare replacement effort, and she hasn’t shied away from defying both her party and a president who did fairly well in her state (though Hillary Clinton won by almost three percentage points).

“There certainly have been stressful moments,” Collins said in an interview with the Globe, sitting in her blue-hued Dirksen office. “Particularly when you know your vote is going to be the deciding vote or likely to be close to the deciding vote.’’

She said the biggest mistake Republican leaders made was not going through the normal committee process, hearing from a range of witnesses. She believes there’s a lesson to be learned for how GOP leaders should proceed on tax reform and infrastructure, two areas she intends to push policy ideas herself.

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“I hope that when it comes to tax reform that we will follow the normal order, go through committee, and have extensive hearings . . . and produce a bipartisan bill,” she said. Obama and Democrats made a mistake when they pushed the ACA through without any GOP support, she said, adding “and I don’t want to see us repeat his mistake whether it’s on health care or tax reform or infrastructure.”

Collins and other moderates were not alone in their concerns about the GOP leadership’s strategy. A bipartisan group of 11 governors, including Massachusetts Governor Charlie Baker, issued a statement urging Republicans to abandon the repeal-and-replace-later approach. “This could leave millions of Americans without coverage. The best next step is for both parties to come together and do what we can all agree on: fix our unstable insurance markets,” the group said.

Republicans are now forced back to the drawing board and may be forced to conduct open hearings to gain public input on solutions to rising costs and coverage gaps in health insurance markets. McConnell’s weeks of secret deliberations for early drafts of his repeal bills gave Democrats ammunition to criticize the process.

Senator Lisa Murkowski, Republican of Alaska, spoke to reporters Tuesday.Manuel Balce Ceneta/Associated Press

Senator Lamar Alexander of Tennessee, the Republican chairman of the Senate Health, Education, Labor, and Pensions Committee, said he would convene hearings in the coming weeks on how to stabilize individual insurance markets, an announcement Collins — a member of the committee — said she encouraged him to make. Alexander told Collins “he wanted to stay very close to me on the issue and get my input,” Collins said, a sign she will continue to play a big role.

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To be sure, the more moderate-minded GOP senators and their concerns about steep cuts to Medicaid did not kill the health care bills on their own. Hardline conservatives were instrumental in the serial defeats, unhappy that the bills did not totally uproot Obamacare along with its Medicaid expansion and coverage mandates.

Several political observers cautioned against extrapolating a moderate resurgence out of the debacle that has become health care, an issue that’s unique in its reach and impact.

Matt Bennett, an executive with Third Way, a centrist think tank in Washington, compared the Republican moderates to the buffalo: “They once roamed the plains freely and in great numbers, but they have been hunted to near extinction.’’

For the GOP, he said, it’s “still dangerous to get too centrist” because they see the threat of a primary opponent in an election as greater than a threat from a Democrat.

“You never know — they might try sanity and decide that they like it,” Bennett said when asked if a bloc of moderates could emerge. “Don’t hold your breath.”


Annie Linskey of the Globe Staff contributed to this report. McGrane can be reached at victoria.mcgrane@globe.com.Follow her on Twitter @vgmac.