REUTERS / Jonathan Ernst

WASHINGTON (Reuters) — Republicans in Congress lacked the votes needed for passage of their U.S. healthcare system overhaul and a key committee chairman came out in opposition after Donald Trump demanded a vote on Friday in a gamble that could hobble his presidency. As a result, shortly before 4 p.m. Friday, House Speaker Paul Ryan pulled the Republican replacement plan from the House floor.

Amid a chaotic scramble for votes, House of Representatives Speaker Paul Ryan, who has championed the bill, met with Trump at the White House. Ryan told the president there were not enough votes to pass the plan, U.S. media reported.

The bill’s defeat suggests that Democratic former President Barack Obama’s signature domestic policy achievement, the 2010 Affordable Care Act dubbed Obamacare, would remain in place despite seven years of Republican promises to dismantle it.

Repealing and replacing Obamacare was a top campaign promise by Trump in the 2016 presidential election, as well as by most Republican candidates, “from dog catcher on up,” as White House spokesman Sean Spicer put it during a briefing on Friday.

The showdown on the House floor follows Trump’s decision to cut off negotiations to shore up support inside his own party, with moderates and the most conservative lawmakers balking. On Thursday night he had issued an ultimatum that lawmakers pass the legislation that has his backing or keep in place the Obamacare law that Republicans have sought to dismantle since it was enacted seven years ago.

“We’ll see what happens,” Trump said at the White House, adding that Ryan should keep his job regardless of the outcome.

The White House said the vote was set for about 3:30 p.m. on Friday on the bill to replace Democratic former President Barack Obama’s signature domestic policy achievement, the 2010 Affordable Care Act, widely known as Obamacare.

“There’s nobody that objectively can look at this effort and say the president didn’t do every single thing he possibly could with this team to get every vote possible,” Spicer told reporters.

Trump already has been stymied by federal courts that blocked his executive actions barring entry into the United States of people from several Muslim-majority nations. Some Republicans worry a defeat on the healthcare legislation could cripple his presidency just two months after the wealthy New York real estate mogul took office.

REUTERS / Jonathan Ernst

“NEUTERING TRUMP”

Rep. Dana Rohrabacher predicted the bill would pass and said voting it down would be “neutering Trump” while empowering his opponents.

“You don’t cut the balls off a bull and then expect that he can go out and get the job done,” Rohrabacher told Reuters. “This will emasculate Trump and we can’t do that. … If we bring this down now, Trump will have lost all of his leverage to pass whatever bill it is, whether its the tax bill or whatever reforms that he wants.”

In a blow to the bill’s prospects, House Appropriations Committee Chairman Rodney Frelinghuysen announced his opposition, expressing concern about reductions in coverage under the Medicaid insurance program for the poor and the retraction of “essential” health benefits that insurers must cover.

“We need to get this right for all Americans,” Frelinghuysen said.

U.S. Rep. Rodney Davis, a member of the House Republican team trying to win passage, said the bill was short of the needed votes while White House budget director Mick Mulvaney added it was unclear if enough support was present.

Vice President Mike Pence, a former House member and influential among Republican lawmakers, postponed a planned trip to Arkansas and Tennessee to try to secure passage.

“I’m still optimistic,” Spicer said, but added, “At the end of the day, this isn’t a dictatorship and we’ve got to expect members (of Congress) to ultimately vote how they will.”

Spicer said whatever happens, Trump still has a “a lot left on the agenda that he wants to get done,” including immigration policy, tax cuts and the U.S.-Mexico border wall.

Trump and House Republican leaders cannot afford to lose many votes in their own party because Democrats are unified in opposition, saying the bill would take away medical insurance from millions of Americans and leave the more-than-$3 trillion U.S. healthcare system in disarray.

Republican supporters said the plan would achieve their goal of rolling back the government’s “nanny state” role in healthcare.

FOREHEAD TATTOO

House Democratic leader Nancy Pelosi said, “What’s happening today is a lose-lose situation for the Republicans. It’s a lose-lose for the American people, that’s for sure. But the people who vote for this will have this vote tattooed to their foreheads as they go forward.”

Failure of the measure would call into question Trump’s ability to get other key parts of his agenda, including tax cuts and a boost in infrastructure spending, through a Congress controlled by his own party.

“If it doesn’t pass, this issue is dead,” Republican U.S. Rep. Mario Diaz-Balart, a bill supporter, said of Republican healthcare legislation. “This is the one shot.”

U.S. stocks were little changed ahead of the vote. That marked a stark contrast with earlier in the week when equities suffered their biggest one-day drop since the election on grounds that the shaky prospects for a successful repeal of Obamacare was a litmus test for everything championed by Trump. “I think investors are of the belief that Trump is just going to pivot to taxes,” said Paul Nolte, portfolio manager at Kingsview Asset Management in Chicago.

Ahead of the vote, leading Republicans took to the House floor to make their case to pass the bill and implored conservatives to seize the opportunity to make good on the party’s long promise to get rid of Obamacare.

“Today we are faced with a stark choice,” said Republican Diane Black, who heads the Budget Committee. “While no legislation is perfect, this bill does accomplish some important reforms.”

Democratic U.S. Rep. Debbie Wasserman Schultz, a breast cancer survivor, called the bill “an immoral piece of legislation” that would gut medical coverage and patient protections.

Obamacare boosted the number of Americans with health insurance through mandates on individuals and employers, and income-based subsidies. About 20 million Americans gained insurance coverage through the law.

The nonpartisan Congressional Budget Office said under the Republican legislation 14 million people would lose medical coverage by next year and more than 24 million would be uninsured in 2026.

Days of negotiations involving Republican lawmakers and the White House led to some changes in the bill but failed to produce a consensus deal.

The House plan would rescind a range of taxes created by Obamacare, end a penalty on people who refuse to obtain health insurance, end Obamacare’s income-based subsidies to help people buy insurance while creating less-generous age-based tax credits

It also would end Obamacare’s expansion of the Medicaid state-federal insurance program for the poor, cut future federal Medicaid funding and let states impose work requirements on some Medicaid recipients.

House leaders agreed to a series of last-minute changes to try to win over disgruntled conservatives, including ending the Obamacare requirement that insurers cover certain “essential benefits” such as maternity care, mental health services and prescription drug coverage.

CLICK ON THE LINKS BELOW FOR RELATED GRAPHICS:

Graphic on Obamacare and Republican healthcare bill http://tmsnrt.rs/2n0ZMKf

Graphic on shifting positions in the U.S. Senate on Republican healthcare bill http://tmsnrt.rs/2mUE4Xf

Graphic on poll on Americans’ views of the Republican healthcare bill: http://tmsnrt.rs/2n7f3e4

Additional reporting by David Morgan, David Lawder, Susan Cornwell, Susan Heavey, Richard Cowan and Doina Chiacu; Writing by Will Dunham; Editing by Bill Trott.