WASHINGTON Senator Mitch McConnell of Kentucky, the majority leader, has long enjoyed a reputation as a master tactician. But when it comes to repealing the Affordable Care Act, he seems to have miscalculated in the first round of play.
He assumed that his conservative and moderate colleagues would come together to make good on their seven-year promise to repeal the health care law, and quickly.
But when he assembled a group of senators to cobble together a health care bill last month, he seemed to go out of his way to exclude some of the most knowledgeable members and moderate voices on health care, like Senators Bill Cassidy of Louisiana, a doctor, and Susan Collins of Maine, an insurance expert and one of the few women in the Senate Republican conference. Views outside of Mr. McConnells on health care did not receive extensive consideration.
When Republicans from states that had expanded their Medicaid programs quickly found themselves at odds with more conservative members who wanted a large rollback of Medicaid, Mr. McConnell did little to allay those worries. Conservatives generally wanted to rein in costs while moderate members wanted to increase spending, particularly in states where health care costs are high and opioid addiction is escalating.
On those key issues, Mr. McConnell put his legislative thumb on the scale in favor of conservatives, quickly alienating many senators from states that had expanded Medicaid, such as Senator Lisa Murkowski of Alaska and Ms. Collins, who became an early and vocal opponent of the bill.
Ms. Murkowski raised concerns on several levels. She expressed worries about soaring health care costs in rural areas, about womens access to health care if Planned Parenthood were defunded, and about how the most vulnerable citizens, such as Alaska Natives, would get health care. Those concerns were largely unanswered.
I certainly wasnt ready, Ms. Murkowski said of voting on the bill after Mr. McConnell announced on Tuesday that it would be put off until after the Fourth of July recess.