WASHINGTON — The Republican health care push was declared dead Wednesday morning. By afternoon it had a breath of life. Legislation in Washington can assume Frankenstein-like qualities.
On the cusp of a humiliating and politically disastrous defeat, President Trump and the Senate majority leader, Mitch McConnell, took extraordinary resuscitative measures on Wednesday to pump oxygen back into their badly fading effort to overturn the Affordable Care Act. They somehow managed to stave off its imminent demise.
It may be only a temporary reprieve, but a fight that seemed finished just hours earlier was renewed and headed for a pivotal vote next week.
With his reputation for being a master of the Senate at grave risk, Mr. McConnell, a Kentucky Republican, extended a new offer to wavering Senate colleagues leery of scrapping the health care law. He backed away from his earlier insistence that the Senate focus on a plan to repeal much of the existing Obama-era law and allow a two-year window for its replacement — an iffy proposition given the difficulties that Republicans are currently having coming up with a consensus health care policy.
Instead, his new selling point was that senators should simply vote next week on a motion to open a rollicking health care floor debate and then let the amendment chips fall where they may — a case of creating national health care policy, which makes up about 20 percent of the United States economy, on the fly.
“What I’m telling you is no harm is done by getting on the bill,” Mr. McConnell told reporters outside the White House after a lunch where Mr. Trump hosted most Senate Republicans. “Wide open for amendment.”
“There’s no way that I, or anybody else, could prevent members from having amendments that any 51 of us can pass and change the bill,” he said by way of encouragement. “But we cannot have a debate until we get on the bill.”
Whether that will be enough to entice Republicans who feared that health insurance proposals crafted by the leadership would do damage to states like Ohio, West Virginia, Maine and Alaska remained to be seen. But there was no rush of outright rejections, and lawmakers planned to assemble with White House staff members to explore options that could win them over.
At the lunch, Mr. Trump mixed threats of political retaliation against Republicans who crossed him with pleas to move ahead with a long-promised repeal-and-replace legislation, urging senators to remain through their August recess if necessary. It was a stark change from his earlier promise to let the health care law collapse and let its beneficiaries face the consequences.
“My message today is really simple,” Mr. Trump told them. “We have to stay here; we shouldn’t leave town, and we should hammer this out and get it done. And not just a repeal,” he said, conceding he had backed that idea before. “I think the people of this country need more than a repeal. They need a repeal and a replace.”
That was good news to Senator Shelley Moore Capito of West Virginia, who had been one of the first Republican senators to balk at moving ahead on an outright repeal plan, along with Senators Susan Collins of Maine and Lisa Murkowski of Alaska.
“I’m glad @POTUS agrees that we cannot move to repeal Obamacare without a replacement plan that addresses the needs of West Virginians,” Ms. Capito said on Twitter.
It is difficult to say how much she and other Republicans — whom Mr. McConnell described as having “some difficulty in getting to yes” — were persuaded by the president’s appeal. But with several days remaining before a vote, Republicans were finding it hard to resist the call to at least make the effort to find some resolution, though many were very skeptical of the chances for success.
The window remaining before the vote also allows both opponents and proponents of the Republican health proposals to step up their pressure on key lawmakers, and they will face an assault.
A coalition of conservative advocacy groups took a harsh line against Republicans who were threatening to derail the health care effort, promising to initiate primary campaigns against them. They noted that all Republican senators who were then in office had voted for a vetoed 2015 repeal plan that would be on the floor next week and that the party had campaigned endlessly on its promises to kill the Obama health care law.
Jason Pye of the group FreedomWorks put Ms. Capito and Senator Rob Portman, the Ohio Republican who had expressed reservations about earlier Republican plans, in the “Senate traitor caucus.”
“Our activist community in Ohio and West Virginia are not going to take this laying down,” he said.
Leaders of the coalition also heaped criticism on Mr. McConnell, questioning his commitment to pushing the health legislation across the finish line. Ken Cuccinelli, president of the Senate Conservatives Fund, referred to Mr. Trump’s pledge to drain the swamp and characterized Mr. McConnell as the “head alligator.”
Mr. McConnell has regularly feuded with the outside groups and gleefully beat back their electoral challenge to him and other Republicans in past elections. Still, it was striking how much fire Mr. McConnell came under, given his push to get some repeal legislation on the floor as well as delivering a Supreme Court seat filled by a conservative — a top priority of those on the right.
The fate of the Republican effort remained precarious, but Mr. McConnell issued a stern warning to any colleagues hoping to dodge a tough vote: They would not get the chance.
“We’re going to vote on the motion to proceed to the bill next week,” he declared.
If it is defeated then, it might be very hard to resurrect.