Senator Rob Portman of Ohio, in particular, formed the spine of opposition to the bill, and pushed for changes to reduce the cuts to Medicaid. In his state, more than 700,000 low-income people have gained coverage through the expansion of Medicaid under the Affordable Care Act.<\/p>\n Senator Susan Collins of Maine criticized the Trump administration\u2019s often specious descriptions of what the bill would actually do, bolstering other more quiet critics\u2019 resolve.<\/p>\n \u201cThe only change that Obamacare made in Medicaid was to give states the option of expanding coverage with increased federal funding,\u201d said Ms. Collins, who opposed the Senate legislation. \u201cYet the Senate bill would have cut hundreds of billions of dollars from this program, imposed an entirely new formula and reduced the reimbursement rate below the cost of medical inflation.\u201d<\/p>\n Advertisement<\/p>\n Continue reading the main story<\/a><\/p>\n The changes, she added, \u201cwould have been made without the Senate holding a single hearing to evaluate the consequences on some of our most vulnerable citizens, rural hospitals and nursing homes<\/a>.\u201d<\/p>\n Mr. McConnell in the meantime did not have enough reliable allies on the right. Mr. Paul made it clear from the start that he would not support anything but a full repeal of the law. Senators Mike Lee of Utah and Ted Cruz of Texas had repeated conversations with Republican leaders and the White House about how to make the bill sufficiently conservative. Senator Dean Heller, Republican of Nevada, dealt an early blow by suggesting he would not support the bill.<\/p>\n Making matters worse for the White House, the bill had virtually no support from health care, insurance, patient advocate and disease groups, and was harshly judged by the Congressional Budget Office. Grass-roots opposition to the bill \u2014 aided by Democrats like Senator Chuck Schumer of New York \u2014 swayed members of Congress in a way rarely seen on Capitol Hill.<\/p>\n Continue reading the main story<\/a><\/p>\n View all New York Times newsletters.<\/a><\/p>\n <\/p>\n <\/p>\n At the annual meeting of the American Hospital Association in May, Mr. Schumer, the Senate Democratic leader, urged hospital executives to mobilize their employees in an effort to defeat the bill, which had been approved by the House just a few days earlier.<\/p>\n \u201cYou have every right to express your outrage on behalf of the people who you take care of and your employees,\u201d Mr. Schumer told hospital leaders. \u201cEveryone needs to speak up and let their elected officials know how bad this bill is.\u201d<\/p>\n The final efforts for the bill began to unravel over the weekend as several Republican senators began to balk at the legislation. Although the Trump administration had dispatched Seema Verma, the new administrator of the Centers for Medicare and Medicaid Services, to the summer meeting of the National Governors Association in Providence, R.I., to try to persuade governors \u2014 and, by extension, the senators in their states \u2014 of the bill\u2019s merits, the governors remained unmoved.<\/p>\n By Saturday night, aides to Senator John McCain of Arizona, who is recovering from surgery<\/a>, announced that he was unable to return from Phoenix this week, leaving Republican leaders another vote short.<\/p>\n By Monday night, as Mr. Trump was meeting with the group of Republican senators at the White House \u2014 not one of whom was on the fence about the bill \u2014 Mr. Moran and Mr. Lee, two senators who were on the fence, issued statements saying they would not support it, a catastrophe for the White House.<\/p>\n Late Monday, Mr. McConnell responded by vowing to pass a measure to repeal the Affordable Care Act now, then work on a replacement over the next two years. But on Tuesday, three Republican senators \u2014 Ms. Collins, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska \u2014 told Mr. McConnell they would not support his last-ditch effort.<\/p>\n Advertisement<\/p>\n Continue reading the main story<\/a><\/p>\n Ms. Capito has generally been an ally of Republican leaders on even really tough votes and once told colleagues that the nearly 180,000 people on Medicaid in her state outnumbered the total number of people who had voted for her.<\/p>\n On Tuesday in Kansas, citizen-activists like Courtney Eiterich, 42, of Lenexa, who has multiple sclerosis<\/a>, were celebrating outside Mr. Moran\u2019s office in Olathe. \u201cI\u2019ve never done this level of political activism before,\u201d said Ms. Eiterich, who had been dogging Mr. Moran for months. \u201cBut if I\u2019m not speaking out, who\u2019s going to do it?\u201d<\/p>\n Mr. Kasich, who had been against the bill, was pleased with the outcome on Tuesday, and recalled conversations he had with Mr. Portman.<\/p>\n \u201cI told him all the time, this is not just about opiates, though opiates are a big part of it,\u201d Mr. Kasich said. \u201cIt\u2019s also about people who suffer mental illness or chronic illness. Rob was trying to figure out how to be constructive, but at the same time, he didn\u2019t want to be taken for granted in terms of his vote.\u201d<\/p>\n Patient advocates, who had major concerns about the bill, were relieved.<\/p>\n \u201cWe joined together in January over a plate of breakfast burritos, so we call ourselves the burrito coalition,\u201d said Sue Nelson, a vice president of the American Heart Association. \u201cWe wrote letters, we brought in patients, we talked to congressional staff until we were blue in the face. We provided members of Congress with hundreds and thousands of stories from patients to let them know how critical it was to preserve affordable health care for their constituents.\u201d<\/p>\n Now what Mr. Trump once described as \u201can easy\u201d process appears destined to stall his policy agenda, and has damaged his diminished standing on Capitol Hill.<\/p>\n Still, the White House is not giving up. Late on Tuesday, Sean Spicer, the White House press secretary, announced that Mr. Trump was inviting all Republican senators to the White House on Wednesday \u2014 to talk about health care.<\/p>\n![\"\"](\"https:\/\/static01.nyt.com\/images\/2017\/07\/19\/us\/politics\/19dc-collapse-2\/merlin-to-scoop-124918352-520397-master675.jpg\")
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\n Tom Brenner\/The New York Times <\/span>
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