Mitch McConnell started the Senate health care debate with an impossible task: reconciling the bitter differences between his conservative senators who wanted to undo as much of Obamacare as possible and more moderate members who were skittish about millions of people losing health insurance.
Now he's given up. The Better Care Reconciliation Act was left for dead Monday night when four senators refused to back the bill and half a dozen more, all moderates, remained undecided. Two months of backroom negotiations and mounting pressure for senators to deliver on their promise to repeal and replace Obamacare still left the plan short.
But the underlying cause of death was the lack of a coherent health care policy vision within the Republican Party.
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Conservatives wanted to unwind as much of Obamacare as they could, whatever the consequences. Moderates were skittish about passing a plan that would lead to millions of people losing health coverage they gained under Obamacare, openly advocating to keep some of the most popular provisions of the 2010 health care law. The two ends of the ideological spectrum also struggled to agree on how deeply to cut Medicaid, both by ending Obamacare's expansion and by putting a hard spending cap on the whole program.
Faced with that reality, McConnell announced late Monday night that he would instead try to force a vote on a bill that would more fully repeal Obamacare with a two-year delay for Congress to figure out a new plan for how to replace it.
But it's not clear that bill would have the 50 votes it needs to pass either. The GOP's hopes for any kind of health care achievement to fulfill seven years of campaign promises are rapidly dimming.