An angry President Donald Trump railed Tuesday against dissenters in his party who dashed his months-long effort to dismantle his predecessor's landmark health care law, as moderates balked at Republican plans to scrap Obamacare without a replacement.

With several efforts to repeal and replace the Affordable Care Act (ACA) now squashed, the Senate's top Republican said he would forge ahead with what could be a last-gasp vote -- on a new plan to kill off most of the 2010 reforms of Trump's predecessor with no replacement at the ready.

A vote to proceed to the bill will be held "early next week," Senate Majority Leader Mitch McConnell told colleagues, even though the effort appeared doomed, with three Republicans declaring their opposition to the plan.

The previous day, four Republicans had lined up against McConnell's earlier health overhaul, flat lining it in the chamber, where the party can afford only two defectors in order to get the measure passed. 

And with Senator John McCain home in Arizona through this week and perhaps longer as he recovers from surgery to remove a blood clot, the room for maneuver is even narrower.

McConnell nonetheless prepared to force a vote to see where his members stood on his latest ploy, the repeal-only measure.

The dramatic implosion effectively means that Trump, who marks his first half-year in office Thursday, has no major legislative victory in hand, squandering months of political capital.

Trump fired off a morning tweet storm complaining about how he was "let down" by Democrats "and a few Republicans" opposed to the repeal.

He had campaigned relentlessly on a pledge to abolish most of the ACA, proclaiming at an October campaign rally that it would be "so easy" to immediately repeal and replace the law.

But he has run into the uncompromising reality of American politics: even with a president's party enjoying a majority in both chambers, crafting and passing landmark legislation can be perilous in the US Congress.

The White House insisted that success remained within reach, with deputy spokeswoman Sarah Huckabee Sanders saying "we are not done with the health care battle."

But Trump could not hide that he was "disappointed," and repeatedly offered that now it would be easier to just "let Obamacare fail."

He also stressed he wanted nothing to do with the blame for the collapse.

"We're not going to own it. I'm not going to own it. I can tell you the Republicans are not going to own it," he said. 

"We'll let Obamacare fail and then the Democrats are going to come to us" to collaborate on a solution.

- 'Time to start over' -

McConnell's new bid would repeal much of Obamacare outright, but with a two-year delay of implementation, in order to allow Congress time to craft a replacement.

A straight repeal bill passed Congress in 2015. That was during Obama's presidency, and Republicans knew they would pay no political price for their votes, as Obama vetoed the measure.

It is no longer a dress rehearsal, and some Republicans are clearly concerned they would be on the hook for any ensuing disruption to the health care system.

Two years ago, the nonpartisan Congressional Budget Office warned that simply repealing Obamacare would essentially kick 18 million people off health care in the first year compared to current law, a figure that would balloon to 32 million by 2026.

That is far worse than the 22 million that the CBO forecast would lose coverage under the latest repeal-and-replace legislation.

With a number of Senate Republican moderates voicing concern about how the latest bill could adversely impact millions of people insured through Medicaid, the health coverage program for the poor and the disabled, McConnell's bid floundered.

"I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians," Senator Shelley Moore Capito said in a statement.

Her state has significant numbers of residents on Medicaid.

Another Republican opposed to the new plan, Senator Lisa Murkowski of Alaska, acknowledged that McConnell had the nearly impossible task of corralling enough votes from his caucus's rival conservative and moderate factions. 

"The majority leader is trying to keep all the frogs in the wheelbarrow, and it's a tough job," Murkowski said. "But he's doing a good job."

While Democrats celebrated, Senate Minority Leader Chuck Schumer extended an olive branch to his Republican rivals and encouraged them to work with Democrats to improve Obamacare.

"It's time to move on. It's time to start over" on health care, he said.

Meanwhile a bipartisan group of 11 governors urged the Senate to "immediately reject" the repeal-only effort and work with state executives on bettering the current system.

"The best next step is for both parties to come together and do what we can all agree on: fix our unstable insurance markets," said the governors, including Ohio Republican John Kasich and Democrat Terry McAuliffe of Virginia.

Source: AFP