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Blow for Donald Trump after vote for healthcare overhaul cancelled

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President Donald Trump suffered a stunning political setback in a Congress controlled by his own party when Republican leaders pulled legislation to overhaul the US healthcare system, a major 2016 election campaign promise of the president and his allies.

Republican leaders of the House of Representatives on Friday pulled the legislation due to a shortage of votes despite desperate lobbying by the White House and its allies in Congress.

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Republicans postpone vote on Obamacare repeal

House Speaker Paul Ryan says Republicans failed to get the necessary votes to repeal and replace the Affordable Care Act healthcare law known as Obamacare.

They had planned a vote on the measure after Trump cut off negotiations with Republicans who had balked at the plan and issued an ultimatum to vote on Friday, win or lose.

Republican moderates as well as the most conservative lawmakers had objected to the legislation. The White House and House leaders were unable to come up with a plan that satisfied both moderates and conservatives.

Trump told the Washington Post: "We just pulled it."

Amid a chaotic scramble for votes, House of Representatives Speaker Paul Ryan, who has championed the bill, met with Trump at the White House before the bill was pulled from the House floor after hours of debate. Ryan said he recommended that the legislation be withdrawn from the House floor because he did not have the votes to pass it, and that Trump agreed.

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Friday's events cast doubt on whether Ryan can get major legislation approved by fractious Republican lawmakers.

"I will not sugarcoat this. This is a disappointing day for us," Ryan said at a news conference, adding that his fellow Republicans are experiencing what he called 'growing pains' transitioning from an opposition party to a governing party.

"Doing big things is hard," Ryan added, noting that he got close but failed to muster the 216 votes needed to pass it.

"Obamacare is the law of land," Ryan told reporters. "It will remain the law of the land until it is replaced. We didn't have the votes to replace this law."

Ryan said he did not know what the next steps would be on healthcare, but called Obamacare so flawed that it would be hard to prop up.

Trump told the Washington Post the healthcare bill would not be coming up again in the near future and that he wanted to see if Democrats who uniformly objected to the Republican plan would come to him to work on healthcare legislation, a Washington Post reporter said on MSNBC.

Without the bill's passage in Congress, Democratic former President Barack Obama's signature domestic policy achievement, the 2010 Affordable Care Act - known as 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 House failure to pass the measure called 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.

News that the bill had been pulled before a final vote was greeted initially with a small sigh of relief by US equity investors, who earlier in the week had been fretful that an outright defeat would damage Trump's other priorities, such as tax cuts and infrastructure spending.

"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 before the legislation was pulled.

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.

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.

Forehead tattoo

After the vote, House Democratic leader Nancy Pelosi said "Today is a great day for our country ... It's a victory for the American people."

Earlier Pelosi, who was instrumental in the passage of Obamacare as House majority leader 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 Representative Mario Diaz-Balart, a bill supporter, said of Republican healthcare legislation. "This is the one shot."

Even if the legislation passes in the House, it faces an uncertain future in the Senate, where Republicans have expressed misgivings.

Healthcare was the first major test of how Trump, a real estate magnate who touted his deal-making prowess in the 2016 presidential campaign, would work with Congress. Days of negotiations led to some changes in the bill but failed to produce a consensus deal.

US stocks were mixed on Friday in early afternoon trading, having pared earlier gains, while US treasuries were mostly higher.

Leading Republicans had taken 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.

Democratic Representative Debbie Wasserman Schultz, a breast cancer survivor, called the bill "an immoral piece of legislation" that would gut medical coverage and patient protections.

A Quinnipiac University poll released on Thursday found 56 per cent of US voters opposed the House bill, with only 17 per cent supporting it. Quinnipiac said its poll had a margin of error of plus or minus 3 percentage points.

Replacing Obama's signature health care plan was a key campaign pledge for Trump and Republicans, who view it as overly intrusive and expensive.

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.

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.

The House and Senate had hoped to deliver a new healthcare bill to Trump by April 8, when Congress is scheduled to begin a two-week spring break.

Reuters