Health vote a pivotal test for GOP, Trump; President warns GOP of fallout if Tuesday bid fails

WASHINGTON - With a strong, last-minute push from President Donald Trump, Senate Republicans face a pivotal vote Tuesday in their long bid to repeal or replace Obamacare.

But the outcome remained in doubt, largely because senators have not even been told which of various GOP plans will be considered.

Senate Majority Leader Mitch McConnell has kept the process highly secretive as he tries to find a path forward amid stark opposition from within his Republican majority, and no backing from Democrats. He has only two Republican votes to spare, and that's if Sen. John McCain returns from Arizona where he's being treated for brain cancer.

Many GOP senators are reluctant to begin formal debate on legislation without knowing where the process will end.

Trump warned senators Monday that Tuesday's planned "motion to proceed" - the first legislative hurdle to passing a Senate bill - could be Republicans "last chance" to undo the Affordable Care Act.

He warned in a tweet that "the repercussions will be far greater than any of them understand!" - hinting of a political fallout for senators who vote against the measure.

"Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare," Trump said during an event at the White House.

"For Senate Republicans this is their chance to keep their promise. Over and over again they said 'repeal and replace, repeal and replace,' " he said. "There's been enough talk and no action. Now is the time for action."

For Trump, a failure Tuesday could expose the limits of his ability to implement his agenda, even with a GOP-controlled Congress.

But neither admonitions from the White House nor pressure from outside conservative groups seemed strong enough to sway some key centrist Republican senators, who continued to express concerns about how the GOP plan might impact low-income residents in their states, particularly those receiving Medicaid.

The nonpartisan Congressional Budget Office estimated that at least 22 million more Americans would not have coverage under the Republican's repeal-and-replace plan, and as many as 32 million would join the ranks of the uninsured if Republicans simply repealed the ACA.

Among the holdouts is Sen. Shelley Moore Capito of West Virginia, a state with a greater share of its population covered by Medicaid than any other. Trump traveled there Monday evening for a rally at the National Jamboree of the Boy Scouts of America.

"Many West Virginians have benefited from our state's decision to expand Medicaid," Capito wrote in her weekly newsletter ahead of the visit. "I am committed to repealing Obamacare and replacing it with a health care system that provides access to affordable care to West Virginians. ... After meeting with President Trump this week, he assured me we are on the same page."

During his remarks in West Virginia, Trump told his Health and Human Services Secretary Tom Price, "You'd better get Sen. Capito to vote for it."

Otherwise, Trump joked, if Price doesn't produce the needed Senate votes, "You're fired!"

Ahead of Tuesday's vote, at least one Republican, Sen. Susan Collins of Maine, remained opposed to proceeding to the bill.

The absence of McCain, who is home in Arizona, further complicated prospects for passage, though there were rumblings that McCain might try to make it back to Washington in time for the vote.

McConnell can afford to lose no more than two Republicans from his 52-seat majority. If needed, Vice President Mike Pence could be called on to cast a tie-breaking vote.

Some GOP senators who initially said they would oppose proceeding to the bill, including Sen. Rand Paul of Kentucky, have since indicated they may be willing to start debate.

Among the centrists, the votes of Capito and Sen. Lisa Murkowski, R-Alaska, remained the most closely watched.

Also not saying how he would vote was Sen. Mike Lee, R-Utah, who opposed the replacement plan.

McConnell nudged senators forward Monday, promising a free-wheeling floor debate that would allow an opportunity to offer amendments to shape the final product.

"We ought to have the debate," McConnell said Monday.

lisa.mascaro@latimes.com

Credit: By Lisa Mascaro; Noam N. Levey - Washington Bureau - lisa.mascaro@latimes.com

Caption: President Donald Trump greets families that oppose Obamacare before a speech about health care Monday at the White House. Trump pushed Republicans to take action.

Alex Brandon/AP