Senate Majority Leader Mitch McConnell (R-Ky.), left, and Senate Majority Whip John Cornyn (R-Tex.) speak with reporters at the White House Tuesday after meeting with President Trump following the postponement of a vote on an overhaul of the nation’s health-care laws. (Jabin Botsford/The Washington Post)

For the past decade, Senate Majority Leader Mitch McConnell has forged a reputation as a closer on big deals. There was the Wall Street bailout just before the 2008 elections. There was the pact over the summer of 2011 to slash spending and avoid a federal default. And there was the 2012 New Year’s Eve “fiscal cliff” compromise to avoid huge tax increases.

But this week, McConnell (R-Ky.) fell short in crafting a Republican plan to repeal portions of the Affordable Care Act and redraw vast amounts of Medicaid policy. Rather than suffer a humiliating defeat, McConnell told his GOP colleagues Tuesday that he would delay a vote until at least mid-July.

This would allow them time to go home over the week of July 4, study the legislation and try to craft a new compromise.

For weeks, McConnell has privately argued that the more they wait, the less likely they are to repeal the 2010 health-care law that President Barack Obama and Democrats approved on party-line votes. Even President Trump, after he summoned GOP senators to the White House on Tuesday, openly questioned whether Republicans will ever live up to one of the central tenets of their party’s orthodoxy by “repealing” what they deride as Obamacare.

If they can’t, it will be a humbling defeat for a Senate leader who thrives on his ability to play the behind-the-scenes game. It illustrates how, 10 years after taking over as Republican leader, McConnell still struggles to corral his caucus and how this has left something missing in his legacy: a sweeping rewrite of big policy along the lines of revamping the health-care system.

(Whitney Shefte,Rhonda Colvin,Malcolm Cook,Bastien Inzaurralde/The Washington Post)

McConnell’s close allies say that issues as high-impact as health care expose senators to fearful reactions from constituents — much more difficult to negotiate than, say, the difference between Republican and Democratic positions on tax rates.

“Yes, it’s harder to do this because there’s a lot of emotional traits in this,” said Sen. Richard C. Shelby (R-Ala.), who was first elected in 1986, just after McConnell in 1984. Shelby has spent nearly three decades next to McConnell on the Appropriations Committee, where they have doled out trillions of dollars over the years — and where the battles were often settled by expanding the size of the pot to make sure each side came away satisfied.

“He is a good inside fighter, and he’s a good strategist,” Shelby said, expressing doubt that enough Republicans will come around on the health-care legislation after a few more weeks of consideration. “I hope he gets his votes.”

Certainly, McConnell’s recent history is filled with important accomplishments. But time and again they involved crunching numbers and splitting the differences with Democrats on the other side of the table — or more likely, the other end of the phone, his preferred negotiating method.

More often than not, McConnell parachuted in at the last minute after others had failed, with John A. Boehner (R-Ohio), the House speaker, playing the role of unencumbered optimist who would often crash and burn. McConnell would then swoop in and find a Democratic ally — usually Joe Biden, when he was vice president, or Harry M. Reid, when he was majority leader — to avert a fiscal disaster.

In 2008, after the first House vote on the Wall Street funds failed, McConnell and Reid (D-Nev.) worked in secret and, after everyone else went home, introduced a new bank bailout that also included billions of dollars in popular, must-pass tax breaks. Within days, the new legislation passed with overwhelming bipartisan support.

Earlier this year, McConnell worked with Senate Minority Leader Charles E. Schumer (D-N.Y.) on a funding bill for this year, angering some conservatives but avoiding a political calamity on the Republican watch.

McConnell acknowledges that trying to revamp the health system is a more difficult task. “Look, legislation of this complexity almost always takes longer than anybody else would hope. But we are going to press on,” he told reporters Tuesday, after a heated Republican policy lunch when he announced the legislation would be delayed until next month.

Health care is bigger than just a few billion dollars here or there, and McConnell is struggling to find that sweet spot. His challenges recall an old quote from Sam Rayburn, the House speaker of the 1940s and 1950s: “Any jackass can kick down a barn, but it takes a carpenter to build one.”

Building a new barn for the health-care industry pits parts of the Senate Republican conference squarely against one another on ideological grounds that are almost impossible for a wheeler-dealer to resolve. On one side are moderates and mainstream conservatives who come from states where governors and legislatures accepted the ACA’s federal funding to expand Medicaid to provide insurance for the working poor.

Those Republicans are wary of quickly eliminating that funding and leaving millions of their constituents without coverage. Yet a larger bloc of Republicans says the moderate request — for more than six years to phase out the new benefit — is little more than a disguised bid to make a permanent expansion of an entitlement program that their party has long tried to rein in as federal deficits swell.

The most ardent conservatives, including former presidential aspirants Sens. Ted Cruz (R-Tex.) and Rand Paul (R-Ky.), have regularly caused headaches for McConnell. Two years ago, in another misstep, McConnell underestimated Paul in a fight over terrorism surveillance laws and was forced to accept a Democratic compromise after a few days when the intelligence program went dark.

Those conservatives have caused other problems in the past, particularly Cruz, whose refusal to yield on a government funding bill over his effort to repeal the ACA in 2013 led to a federal government shutdown in October of that year.

Now in the majority, McConnell is trying to use budget rules to pass this repeal on a simple majority vote with just Republican votes, unlike his past deals. However, after the meeting with Trump, in a subtle nod to his past, McConnell warned that if Republicans refused to compromise among themselves, he would go back to his old ways and find a Democratic partner to pass something that was much less favorable to conservatives.

“It will be dealt with in one of two ways,” McConnell said outside the White House Tuesday. “Either Republicans will agree and change the status quo or the markets will continue to collapse and we’ll have to sit down with Senator Schumer.”

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