IOWA CITY — Sen. Joni Ernst (R-Iowa) looked out at hundreds of Democrats crowded into a tense town hall meeting Friday afternoon and told them that they'd won. Just an hour earlier, Sen. John McCain (R-Ariz.) had come out against the GOP's latest attempt to repeal the Affordable Care Act on partisan terms.
"I hope that Lamar and Patty can come back again together, hopefully next week," said Ernst, referring to Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.), who had been working on a bipartisan bill to stabilize the ACA. "We can pick back up and try again."
But Republican leaders have not yet declared defeat on their repeal effort. On Saturday, President Trump applied a new round of pressure on Republican senators to back the bill authored by Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.). And Graham's spokesman said he was "pressing on."
Republican Senate aides have hinted in recent days at the possibility that new language in the bill might be released at some point. On Saturday, Health and Human Services Secretary Tom Price said in an interview on Fox News that Republicans were "refining" the legislation. Still, there are no clear resolutions to the problems facing Trump and Senate Majority Leader Mitch McConnell (R-Ky.): Time and diminishing support.
Senate leaders only have until the end of the month to take advantage of a procedural rule that allows them to pass their bill without Democratic support. And if one more Republican senator comes out against their plan, it will lack the votes to succeed.
Compounding their challenge: Even senators who intended to vote for the bill, such as Ernst, sound ready for another option.
Democrats on Saturday encouraged their supporters not to let up their resistance to the repeal and brace for a final GOP push when Senate Republicans gather for a pivotal weekly policy lunch at the Capitol on Tuesday.
"Healthcare bill has 2 no votes. We need 3. With 4 or more we might be done for a while. Tues GOP meet, decide. We have momentum. Let's win," Sen. Brian Schatz (D-Hawaii) wrote on Twitter.
The White House is asking for one more try. In a series of tweets Saturday, Trump wrote that McCain had "let Arizona down" and that other skeptical senators needed to give the GOP, and their constituents, some kind of win. He later tweeted that Democrats are laughing that McCain had a "moment of courage."
"I know Rand Paul and I think he may find a way to get there for the good of the Party," Trump wrote about the senator from Kentucky, who has also come out against the bill. A Paul spokesman did not immediately respond to a request for comment Saturday on his latest position. Sen. Susan Collins (R-Maine) has also said that she is leaning toward voting "no."
In a tweet aimed at Sen. Lisa Murkowski (R-Alaska), a key swing voter who remained uncommitted on Saturday, Trump shared a misleading statistic about premium increases — the largely rural state has tamed them with subsidies — and insisted: "deductibles high, people angry!"
On Saturday, Price rejected the notion that the health bill was doomed.
"The reason it's not dead is because it's not finished," Price said on Fox News. "The bill hasn't been completed. We continue to work with the authors on it through this weekend, and the bill will be likely rolled out early next week."
Holdout senators are concerned that the latest repeal bill won't solve the problem of high premiums that had made the ACA politically toxic.
It is clear that the bill, which would cap Medicaid spending and send it to states as block grants, is unpopular. In a new Washington Post/ABC poll, just 33 percent of voters said they supported the Cassidy-Graham plan.
"We need to be clear to them that they're courting electoral disaster if they support this bill," said Ben Wikler, the Washington director of MoveOn, which has organized scores of rallies ahead of the Sept. 30 repeal deadline. "There will be a 30-ring circus of protests if they go and do this again."
For most Republicans, the political costs are theoretical. In the Senate, the Democrats' battle to save the ACA has focused on a half-dozen Republicans who might switch their votes. Forty-three Republicans, however, voted for every repeal version, and 49 seemed ready to pass any bill that could be routed back to the House.
The ACA battle, ending and restarting every few weeks with a dizzy rhythm, has created a network of protesters and citizen lobbyists who have pressured Ernst and Sen. Charles E. Grassley (R-Iowa) — and before that, the state's three Republican congressmen — with phone calls, sit-ins and bracing town halls.
In Iowa, where Trump's 2016 coattails swept Democrats out of power, Republicans had partially privatized Medicaid and rallied behind repeal. Republican Gov. Kim Reynolds, who took office in May after her predecessor became the U.S. ambassador to China, was one of just 16 Republican governors to endorse the Cassidy-Graham repeal bill. In Iowa City, and at a Thursday town hall in more conservative Charles City, Ernst pushed back at some Democratic protesters by pointing out that their candidates had lost the last elections.
"The president ran on repeal, and he won Iowa by nine points," Ernst said in Iowa City, keeping a steely demeanor as the audience — more than 750 people in the most liberal part of the state — erupted with boos.
Elected in 2014, Ernst was one of nine Republicans who won control of formerly Democratic seats during the backlash over the ACA's implementation. Nearly three years later, with a Republican administration managing the law and deciding whether to grant waivers to states, it was harder to make a black-and-white case for repeal.
Grassley had discovered that days before McCain's decision. "I could maybe give you 10 reasons why this bill shouldn't be considered," Grassley told Iowa reporters Wednesday. "But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign."
Grassley's quote resonated with the protesters who flooded Ernst's three town halls. In Charles City, two different constituents asked Ernst if she agreed with Grassley; the senior senator, Ernst said, had to speak for himself.
In Charles City on Thursday, nearly two dozen protesters, organized by the Indivisible group, dominated the hour-long Q&A. Ellen Doll, 70, arrived with a large photo of her 44-year-old son, whose full-time care at a rural hospital had been cut back since 2016, and asked Ernst to explain why Medicaid caps and privatization would not put him on the street.
"The money, the dollars, will still increase," Ernst said. "You won't see cuts from the current year."
"It's a slower rate!" Doll said.
"Well, I'd have to see the numbers," Ernst said.
In Iowa City, there were more boisterous questions. Ernst ignored or talked over hecklers, and noted it when they seemed to be screaming over the answers.
"Really, if I said anything — if I said the sky was blue with regard to this health-care bill — you would disagree," she said.
When the talk turned away from Cassidy-Graham, however, Ernst found a receptive audience. On Thursday, she had accused Democrats of walking away from the bipartisan talks, emphasizing that she had been part of them. On Friday, with the repeal push fading, she repeatedly said that she wanted the talks to succeed.
"We have to work together to figure out a solution," she said. "Right now, Iowa's health insurance system is imploding. We've got families that can't afford insurance. I can't give up on this."
At a news conference after the town hall, Ernst described her goals for health care.
"Making sure that Medicaid remains available," she said. "Making sure that we are protecting, in whatever manner, those who have preexisting conditions."
But her pitch sounded more like what Republicans ran on in 2014 — and not what had been packed into the latest GOP plan.