WASHINGTON _ Don't bet on Obamacare being repealed and replaced this summer, or even this fall. Or maybe even this year.
Nine Republican senators face re-election in 2018. While seven appear safe, turmoil over health care could change the equation quickly, and Republicans can only afford a net loss of three seats. The GOP currently controls 52 Senate seats.
Problems are surfacing in the Senate. There's disagreement among Republicans over how to proceed with Medicaid, which helps pay health care bills for the poor. And GOP senators are mired in controversy over just who's supposed to be writing the legislation.
"McConnell has a very narrow margin of error on this," said Darrell West, vice president and director of governance at the Brookings Institution, a center-left Washington policy organization.
Asked by reporters Tuesday whether he was confident he could get a health care bill done this year, Senate Majority Leader Mitch McConnell of Kentucky avoided answering the question.
Other Senate Republican leaders were vague. When asked what he thought was a realistic time frame for getting a bill through the Senate, Sen. John Thune of South Dakota, the Republican conference chairman, said "sometime this summer." But any bill would still have to be reconciled with the House version, a process that could take awhile.
Other business also could get in the way. Congress needs to pass a budget that keeps the government running past Oct. 1, the start of the fiscal year. President Donald Trump has signaled he's going to seek big cuts in popular domestic programs, cuts sure to mean political danger for those vulnerable Republicans.
At the same time, lawmakers are probably going to get a tax overhaul plan from the White House. Plus, they have to reauthorize the Federal Aviation Administration by Sept. 30.
Time could run short. The Senate has been working Monday night through Thursday afternoons. It's due for weeklong recesses the weeks of Memorial Day and Fourth of July, and then a break from July 28 through Sept. 5.When Democrats pushed the Affordable Care Act through Congress in 2009 and 2010, they had a 60-vote Senate majority part of the time and an actively engaged president. It took them a total of 14 months from start to finish.
"The decision about when it ultimately gets it into the queue has as much to do with the pipeline of other matters," said Sen. Thom Tillis, R-N.C. "It's going to take a little bit of time."
The House took the first big step of 2017 last week, narrowly approving a health care overhaul bill by a razor-thin 217-213 vote. The Senate is going to write its own version.
McConnell has to satisfy Republicans from states that expanded Medicaid under Obamacare, including Sen. Shelley Moore Capito of West Virginia.
"They're not going to want to see major cutbacks in that program," West said. "It would be devastating in their states."
He has to protect at least one incumbent who's up for re-election, Sen. Dean Heller of Nevada, whose home state voted for Democrat Hillary Clinton last year and who faces re-election in 2018. So does Sen. Jeff Flake, R-Ariz., who appears to be in good shape but represents a state that Trump carried with only 49.5 percent.
On the right flank, McConnell has to keep the conservative renegades on board, notably Sens. Ted Cruz of Texas, Mike Lee of Utah and Rand Paul of Kentucky.
"It's going to take a little bit of work to get me to a 'yes' vote," Paul told Fox News, "but I do have an open mind."
The Republican fissures were clear Tuesday, the first time senators gathered to meet on how to proceed.
There was controversy over the makeup of a 13-member Republican working group named last week to deliberate over legislation. But controversy erupted over its all-white male makeup. A separate group held a meeting on Medicaid policy.
By Tuesday afternoon, McConnell said: "The working group that counts is all 52 of us, and we're having extensive meetings, as I said a few minutes ago, every day. Nobody's being excluded based upon gender."
He insisted that "we're having a discussion about the real issues. Everybody's at the table _ everybody."
Even if Republicans can produce a bill that satisfies different constituencies within the Senate majority, it will have to go through a lengthy negotiation period with the House of Representatives. After a false start earlier this year, the House last week narrowly passed a compromise bill, but senators have made clear that they aren't simply going to rewrite the House's bill.
"There's going to have to be a lot of consultation within the Senate," West said.
Tillis said it could take several weeks for Senate Republicans to reach consensus. Sen. James Lankford, R-Okla., said lawmakers would lose a month while the bill is analyzed by the Congressional Budget Office.
"There's no way it's going to be less than a month," Lankford said. "It's a minimum of a month, not including the negotiations."
The nonpartisan CBO, when it analyzed the initial version of the House bill, said it could cause 24 million Americans could lose health coverage over a decade. It still hasn't analyzed the bill the House passed.
West said it's not unusual for the party in the White House to lose seats in Congress in the first midterm election, and that because of the health care controversy, Republicans may have as much at stake in 2018 as Democrats did in 2010.
"There's so much discontent in the country," West said. "Nobody should feel safe."
