WASHINGTON – The slumping Republican push to revamp the Affordable Care Act has raised the practical prospect that changes to the law can only be accomplished with bipartisan agreement.

But don’t count on it, given the opposite policy goals of Senate Republicans and Democrats.

Democrat Minority Leader Chuck Schumer of New York extended an olive branch in advance of the contentious decision by GOP leaders Tuesday to rush some version of a Republican-only health care bill through the Senate this week.

Schumer urged the do-or-die effort be set aside in favor of both parties negotiating legislation to fix the current law’s flaws but not drastically repeal it. 

“We can work with you,” Schumer said. “We know the ACA (Obamacare) is not perfect. But we also know what you’ve proposed is much worse.”

Yet no Republican -- and particularly not Majority Leader Mitch McConnell of Kentucky -- took Schumer’s offer seriously, though Sen. John McCain of Arizona suggested as much in his remarks on the Senate floor Tuesday.

Instead, McConnell charged ahead with repeal and replace, and partial repeal proposals – both of which failed due to insufficient support within the 52-member Republican majority. A so-called “skinny repeal” proposal remained on the table, but no sign of bipartisan cooperation.

That’s because McConnell and Schumer have very different objectives.

McConnell is driven by the GOP promise to replace Obamacare ever since it became law in 2010, and the taxes and insurance mandates that go with it.

Schumer and his minority members are determined to preserve the fundamentals of Obamacare, especially its Medicaid and government-provided insurance features.

Democrats have repeatedly said they are willing to work with Republicans on problems with the Obamacare insurance exchanges, and efforts to bring down skyrocketing insurance premiums and deductibles.

That’s not going to happen, as in speech after speech, Republican bosses  call on rank-and-file GOP holdouts to keep the party’s campaign promise to get rid of Obamacare in one form or another.

Democrats’ refusal to support any Republican-only proposal puts the GOP in a tight corner, as evidenced by Monday’s slimmest of votes to even debate the party’s overhaul proposals.

With but a two-vote majority, they can only spare two defections. Nine GOP senators voted against the first repeal and replace bill on the Senate floor, and seven voted against the partial repeal measure.

Though united in wanting to revamp some of the health care law’s regulations, Republicans remain divided over proposed cuts to Medicaid and federal subsidies.

The most likely path now is for passage of the GOP “skinny repeal” plan that gets rid of individual and employer insurance mandates, and the medical device tax.

It is a Republican fallback position that doesn’t touch Medicaid and keeps a GOP-only Senate bill alive for consideration by House and Senate conference committee negotiators to reach a final compromise.

According to a Kaiser Family Foundation poll earlier this month, 71 percent of respondents want Republicans to work with Democrats to improve Obamacare instead of repealing it. One-fourth want Republicans to continue working on their own to repeal and replace the law.

Contact Washington reporter Kery Murakami at kmurakami@cnhi.com.

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