After weeks of closed-door deliberations on their version of Obamacare repeal and replacement legislation, Senate Republicans and Majority Leader Mitch McConnell are peddling it to a reluctant flock, amid solid Democratic opposition.
Needing 50 Republican votes of the 52 available (plus Vice President Mike Pence to break a tie), Mr. McConnell is tasked with overcoming the outspoken dissatisfaction of several Republican senators to push the secretly shaped legislation across the finish line and then back to the House, which narrowly approved its own version months ago.
Four conservative senators — Rand Paul of Kentucky, Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah — quickly staked out strong negotiating cards to achieve various changes in the Senate bill to replace Obamacare, a national health-care concept that the party historically has never embraced. Upon the release of a 142-page summary of the Senate bill, the four released a written statement saying: "Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation."
Late Friday, Sen. Dean Heller of Nevada, who is up for re-election next year, issued his own statement rejecting the bill "in this form." Two other Republican senators, Susan Collins of Maine and Lisa Murkowski of Alaska, told reporters they would endeavor to retain support of certain Planned Parenthood work under the bill.
The fight over governmental involvement in national health care has long been an ideological argument between the major parties. In the 1990s, congressional Republicans successfully derailed an early Democratic version crafted in somewhat similar secrecy by then first lady Hillary Clinton.
But they failed in 2010 to defeat the Affordable Care Act, which they promptly labeled Obamacare, to President Barack Obama's satisfaction. Ever since, "repeal and replace Obamacare" has been the war cry of the GOP.
It has been embraced now by President Donald Trump, without his personal involvement in the legislative sausage-making. Shortly after the summary of the McConnell bill was made public, he tweeted: "I am very supportive of" the Senate version. "Look forward to making it really special! Remember ObamaCare is dead."
The latter remark was an unsubtle reminder to the Trump faithful of his 2016 campaign pledge to kill it, although the Senate version retains two specific Obamacare features that he and many Republican voters have indicated they want retained: insurance coverage for enrollees' pre-existing health conditions (although it allows states to weaken that protection) and for dependent children up to age 26.
The somewhat late-blooming Republican embrace of some sort of national health-care insurance after years of opposition was fueled by an earlier Congressional Budget Office "scoring" of the likely ramifications of enactment of the House version. It indicated 24 million Americans would lose coverage under it, and a CBO estimate under the Senate version is expected soon, with similar result. Mr. McConnell has indicated a Senate vote will be sought before the congressional recess over the July 4 holiday, during which most legislators will go home and sample voters' reactions to the first months of the Trump presidency and the success or failure of his pledge to end Obamacare.
Republicans no doubt anticipate a well-financed Democratic campaign to recapture one or both houses of Congress next year, and they know the fate of the Trump presidency itself could be at stake then.
The Democrats suffered at least a psychological blow last week when they lost a fight for a Republican House seat in Georgia earlier held by Tom Price, a fierce Obamacare foe who left Congress to become Trump's secretary of health and human services.
Accordingly, the issue of affordable health care for all Americans, whether through private insurance or a new government-financed system serving a greatly expanded field of beneficiaries, has become the dominant political challenge of this era.
Mr. Trump's policy to date has been essentially to give only general endorsement. He has shifted to the Republicans in Congress the task of coming up with the very complicated mechanism to achieve it, without shattering the social safety net that has embodied the very conscience of the nation. Will he now personally engage in constructive leadership, rather than merely bragging he will make American great again?
Jules Witcover is a syndicated columnist and former long-time writer for The Baltimore Sun. His latest book is "The American Vice Presidency: From Irrelevance to Power" (Smithsonian Books). His email is firstname.lastname@example.org.