House Republicans beat an embarrassing retreat on health care Thursday, postponing a long-promised vote to repeal Obamacare after President Trump struggled to sway reluctant conservatives who said the GOP replacement wasn’t good enough.
Hoping for a marquee victory seven years to the day after the Affordable Care Act was signed into law, Republican leaders instead found themselves caught in the same trap that dogged Democrats in 2010, trying last-minute deals to shore up support before a self-imposed deadline.
Republicans said they will try again Friday, after Mr. Trump’s top aides delivered a final ultimatum to a closed-door GOP meeting Thursday night. They agreed to one final series of changes but said that’s it, and Republicans need to either approve the plan or move on.
“There were folks who thought we could negotiate additional changes. It’s loud and clear tonight, this will be a one-and-done, up-or-down [vote],” said Rep. Chris Collins, New York Republican and a Trump backer. “If it’s down, we’re done.”
The last-minute changes included zeroing out Obamacare’s essential health care benefits, which was the mandate requiring all plans to cover maternity care, prescription drugs and mental health services. Conservatives said those mandates made customers pay for care they may never need.
Republican leaders also said they will keep one of Obamacare’s taxes on high-income workers for six more years, freeing up $15 billion to add to a fund designed to help states cover sicker consumers.
Thursday’s failure was a black mark for the White House and Speaker Paul D. Ryan, the Wisconsin Republican who insisted they would be able to cajole enough votes when the time came to put their bill on the floor.
They began the debate Thursday morning but quickly realized they weren’t making enough headway and shut down the House for most of the day, retreating behind closed doors to argue it out.
Mr. Trump and Mr. Ryan are stuck between centrist Republicans, who say the bill will harm the most vulnerable and hard-line conservatives who insist the plan didn’t go far enough in undoing Obamacare, denying Mr. Trump the votes he needs to fulfill a core campaign promise and create momentum for the rest of his agenda.
The GOP’s uphill climb got steeper Thursday after budget scorekeepers said a round of changes designed to bring restive conservatives on board reduced some of the bill’s red ink but wouldn’t make a dent in the number of people pushed off insurance or lower the costs of premiums.
“Apparently they still do not have the votes to pass the bill, and are working to make it even worse,” said House Minority Leader Nancy Pelosi, California Democrat.
Republican leaders passed off the delay as the ugly byproduct of legislating for a Congress that has had little practice in recent years.
Mr. Trump met personally with some holdouts but couldn’t seal the deal — though his targets praised him for trying.
“I think it’s indicative of just a president that wants to solve problems,” said Rep. Mark Meadows, North Carolina Republican and chairman of the hard-line House Freedom Caucus.
Mr. Meadows emerged from a two-hour huddle with his members to say they were still unswayed, denying Republican leaders the margin of victory.
“I’m desperately trying to get to yes,” Mr. Meadows said. He said he was still a “no,” and that he’d have to speak with the rest of the caucus to find out if they were swayed by Mr. Trump’s ultimatum, adding that “anytime you don’t have 216 votes, negotiations are not totally over.”
Still, all sides played nice in front of the cameras. White House press secretary Sean Spicer thanked the Freedom Caucus for working closely with the president. He also predicted eventual victory.
“We walked out with more members in support of the American Health Care Act today than we started the day with,” he said. “And I continue to see that number climb hour by hour. I anticipate that we will get there. We continue to see the number go up, not down, and that’s a very positive sign.”
Hard-liners had begged for the essential coverage change Republican leaders agreed to Thursday night, but weren’t ready to go along with another request to cut regulations known as “community rating.” That system requires insurers to charge people in a given area the same price, no matter whether they are sick or healthy.
Republican leaders feared dropping those rules would fragment the already fragile GOP coalition, with moderates skittish about how far the bill goes.
Rep. Dan Donovan, one of those moderates, said he plans to vote against the bill Friday.
But he rejected the White House’s insistence that negotiations are over if the bill fails and said he didn’t think his vote would sour his relationship with Mr. Trump.
As written, the Republican plan repeals most of Obamacare’s taxes and its mandate requiring Americans to hold insurance, replaces its generous subsidies with refundable, age-based tax credits and reins in and caps spending on Medicaid, the insurance program for the poor.
Mr. Ryan says the bill not only guts Obamacare but also secures huge conservative wins by overhauling a major entitlement program and stripping federal funds from Planned Parenthood as punishment for its abortion practice.
Republicans can’t afford to lose more than 22 votes, however, and party centrists were fleeing the plan this week.
Rep. Jaime Herrera Beutler of Washington announced her opposition Thursday, one day after Reps. Charlie Dent of Pennsylvania, Daniel Donovan of New York, Frank A. LoBiondo of New Jersey and David Young of Iowa entered the “no” column.
Democrats heckled Republicans from the sidelines, saying Republicans were rushing to throw millions of people out of their current coverage.
“Please, please. I would ask my colleagues to slow down, be thoughtful. This is not a game. You don’t get extra points for being fast,” said Rep. Jim McGovern, Massachusetts Democrat.
Republicans who took part in several closed-door meetings across the Capitol defended themselves to trailing reporters.
“This is called legislating,” said Rep. Bill Johnson, Ohio Republican. “This is called deliberating.”
• Dave Boyer, Stephen Dinan and Seth McLaughlin contributed to this report.