Trump scolds Senate Republicans for failing to agree on health care

US President Donald Trump scolded Senate Republicans on Wednesday for failing to reach agreement on repealing or overhauling Obamacare, demanding they keep their campaign promises and find a new health care approach.

Trump told 49 senators who came to a White House lunch that they should not leave Washington for a planned August recess until they can find common ground on health care.

"We're close. We're very close," Trump said at the start of the lunch meeting, a day after the seven-year Republican quest to repeal and replace Democratic former President Barack Obama's signature health care law seemed to collapse in the Senate.

"For seven years you promised the American people you would repeal Obamacare. People are hurting and, frankly, inaction is not an option," Trump told the Republican lawmakers. "Any senator who votes against starting debate is really telling America that you're fine with Obamacare."

Senate Majority Leader Mitch McConnell has vowed to go ahead with a vote early next week on a repeal of the Affordable Care Act 2010, popularly known as Obamacare, despite indications it will fail after the defections on Tuesday of at least three Republican senators.

"I think we all agree it's better to both repeal and replace, but we could have a vote on either. And if we end up voting on repeal only, it will be fully amendable on the Senate floor," McConnell told reporters outside the White House after a lunch with President Donald Trump.

"And if it were to pass without any amendment at all, there's a two-year delay before it kicks in. So, the takeaway from what I'm telling you is – no harm is done by getting on the bill. Wide open for Amendment. No matter what I offer as a substitute first, it's fully amendable."

Moderate Republican senators Susan Collins of Maine, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia said they oppose McConnell's plan for a repeal that would take effect in two years, giving Congress time to develop a replacement. All three attended the lunch.

With Democrats united in opposition to repeal, McConnell can only lose two votes from his 52-48 majority in the 100-seat Senate to pass health care legislation.

Trump, who had not been heavily involved in lobbying the Senate on the issue until this week, said he wanted more than a straight repeal vote and wanted the Senate to pass a replacement measure as well.

"We can repeal, but we should repeal and replace and we shouldn't leave town until this is complete," he said.

But the reality has been difficult for a party divided between moderates concerned the Senate bill would eliminate insurance for millions of low-income Americans and conservatives who want to see even deeper cuts to Obamacare, which boosted the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies.

Immediate hurdles to health care

If senators try to shore up Obamacare, an initial hurdle in coming weeks will be boosting faltering state insurance markets by ensuring that insurers keep receiving subsidies that help lower the cost of insurance for low-income individuals.

The Trump administration will continue making the subsidy payments through August while a related Republican lawsuit is pending. The uncertainty beyond that has rattled insurers.

Republican senators have acknowledged the need to address the unstable markets but resisted Democratic calls to fund the subsidies without accompanying reforms, calling it a "bailout" for insurance companies.

Funding for the Children's Health Insurance Program, a part of the Medicaid government health insurance program for the poor and disabled, known as CHIP, expires on September 30 and will require reauthorisation.

Bills to address the subsidy payments and CHIP would likely require 60 votes for passage, acting as a barometer of how inclined Republicans and Democrats are to work together, industry lobbyists and experts said.