Congressional Republicans, emboldened by their narrow majority, pushed their luck from Day 1. Not content simply to pull apart the health care law, they took the repeal efforts as a license to make broad-based changes to Medicaid, with provisions that would have capped spending annually and ended the open-ended entitlement for the poor after 50 years, without so much as a public hearing. This was a bridge too far for moderate Republicans and those from states where the party commands fierce loyalty but where poor residents benefit in some form from the law.
Republicans had a math problem on both ends.
On the right, senators like Rand Paul of Kentucky and Mike Lee of Utah were going to be satisfied only with a bill that repealed the Affordable Care Act in its entirety.
But senators from states that had expanded their Medicaid programs — like Shelley Moore Capito of West Virginia, Rob Portman of Ohio and Lisa Murkowski of Alaska — had to contend with alarmed governors and other state officials who faced the choice of leaving constituents uncovered or raising taxes to extend their insurance. Attempts to mollify them were largely unsuccessful: Ms. Murkowski, for example, was awarded a special provision to compensate for the expected explosion of premiums in her state. But this concession also exposed her to potential criticisms of legislative kickbacks.
The process itself was not helpful. Senator Mitch McConnell of Kentucky, the majority leader, tried to work with a select group of senators who largely represented a conservative view. But without hearings, committee work or a public drafting of the bill — all marks of the original health care law — members on both sides of the divide felt bruised and left out.
Congressional Republicans got little help from the White House, which was at turns disengaged and counterproductive. White House officials and many Republicans seemed to be more dedicated to their true love, changes to the tax system, than to…