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WASHINGTON (Reuters) - The seven-year Republican quest to scrap Obamacare, a major campaign vow by President Donald Trump, lay in ruins on Friday after the Senate failed to dismantle the healthcare law, with congressional leaders now planning to move on to other matters.

John McCain, the maverick 80-year-old senator and 2008 Republican presidential nominee, cast the deciding vote in the dramatic early-morning showdown on the Senate floor as a bill to repeal key elements of Obamacare was defeated, 51-49, dealing Trump a crushing political setback.

McCain, who flew from Arizona this week after being diagnosed with brain cancer and was heading back for further treatment starting on Monday, joined fellow Republicans Susan Collins and Lisa Murkowski in voting with Senate Democrats unified against the legislation.

"It's time to move on," Senate Majority Leader Mitch McConnell, whose reputation as a master strategist was diminished, said on the Senate floor after the vote at roughly 1:30 a.m. (0530 GMT).

While House of Representatives Speaker Paul Ryan said fellow Republicans should not give up on healthcare, he cited other pressing issues that needed attention, including major tax-cut legislation sought by Trump.

"We have so much work still to do," Ryan said in a statement.

The Senate's healthcare failure called into question the Republican Party's ability to govern even as it controls the White House, Senate and House of Representatives.

Trump has not had a major legislative victory after more than six months in office, and his administration is mired in investigations into contacts between his election campaign and Russia and high-level White House staff infighting. He had promised to get major healthcare legislation, tax cuts and a boost in infrastructure spending through Congress in short order.

Also on the legislative agenda are spending bills for the fiscal year beginning Oct. 1 to avoid a government shutdown and raising the U.S. debt limit.

Speaking in Brentwood, New York, on Long Island, Trump expressed dismay at the bill's failure, saying, "I said from the beginning, let Obamacare implode and then do it (pass legislation). I turned out to be right. Let Obamacare implode."

Trump, who earlier on Twitter said the three Republicans who voted no "let America down," again took aim at lawmakers in his own party. "Boy, oh boy, they've been working on that one for seven years," he said in Brentwood. "Can you believe that? The swamp. But we'll get it done."

Some lawmakers urged a bipartisan effort to buttress the existing healthcare system. With the partisan divide as wide as ever in Washington, it remained to be seen if a bipartisan approach can get off the ground.

McCain said the defeated bill did not offer meaningful reform and that its defeat presents "an opportunity to start fresh" on legislation crafted by lawmakers in both parties.

"I encourage my colleagues on both sides of the aisle to trust each other, stop the political gamesmanship and put the healthcare needs of the American people first," McCain said.

Top congressional Democrats urged a bipartisan effort to fix problems in the Obamacare law without repealing it. "Change it, improve it, but don't just take a knife and try to destroy it and put nothing in its place," top Senate Democrat Chuck Schumer said.

Democratic Senator Bill Nelson said he was working with Republican Collins on a bipartisan effort on healthcare.

While Ryan was able to secure House passage of a comprehensive bill to gut Obamacare in May, McConnell earlier in the week was unable to win passage of similarly broad healthcare legislation amid intraparty squabbling and competing demands by hard-line conservatives and moderates. On Friday morning, he failed to get even a stripped-down, so-called skinny bill over the finish line.

Killing the Affordable Care Act, Democratic former President Barack Obama's signature domestic policy achievement dubbed Obamacare, has been a passion for Republicans since its 2010 enactment over their unified opposition, and was a key campaign promise by Trump last year.

Republicans lawmakers, some of whom have been gleeful about razing Obama's presidential legacy, now fear a backlash from their conservative political base that could affect the 2018 congressional elections.

For the moment, the Affordable Care Act, which extended health insurance to 20 million people and drove the percentage of uninsured people to historic lows, remains in place and must be overseen by an administration that is hostile to it.

This leaves health insurers unsure of how long the administration will continue to make billions of dollars in Obamacare payments that help cover out-of-pocket medical expenses for low-income Americans.

Schumer warned against any efforts to sabotage the law.

The Blue Cross Blue Shield Association, which represents insurers across the country, said it would work to ensure a smooth open enrollment period from Nov. 1-Dec. 15 and stabilize the individual insurance market under Obamacare for the long term.

Shares of health insurers, which had fought against the bill's proposed repeal of the mandate that Americans obtain insurance, were up. Aetna Inc rose 0.9 percent, Anthem Inc gained 2.3 percent and Humana Inc edged up 0.2 percent.

On Wall Street, shares of hospitals were mostly higher because of the dwindling prospects for big cuts in the Medicaid insurance program for the poor and disabled. Community Health Systems Inc rose 2.2 percent, HCA Healthcare Inc gained 0.6 percent and Tenet Healthcare Corp edged up 0.1 percent. Republicans have long denounced Obamacare - which expanded Medicaid and created online marketplaces for individuals to obtain coverage - as an intrusion by government on people's healthcare decisions.

Veteran House Republican Tom Cole said he thought there were "a number" of other Republican senators who were uncomfortable with the Senate's healthcare legislation but were able to vote "yes" knowing McCain's vote would kill it.

Republican Senator Lindsey Graham, a close friend of McCain, met on Friday with Trump to discuss Graham's proposal to take tax money raised by Obamacare and send it back to the states in the form of healthcare block grants, the senator's office said.

The skinny bill, released just three hours before voting began, would have retroactively repealed Obamacare's penalty on individuals who do not obtain health insurance, repealed for eight years a penalty on certain businesses that do not provide employees with insurance and repealed a tax on medical devices until 2020.

Reporting by Susan Cornwell and Richard Cowan; Additional reporting by Doina Chiacu, Roberta Rampton, Yasmeen Abutaleb, Rodrigo Campos, Amanda Becker, David Morgan and Eric Walsh; Writing by Will Dunham; Editing by Frances Kerry and Jonathan Oatis

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Republicans try to pick up the pieces after healthcare defeat - Reuters

In the year since Donald Trump won the Republican presidential nomination, party leaders have been reluctant to challenge a man who has formed a tight bond with conservative voters, even when he upset party orthodoxies and norms of presidential behavior.

But that reticence is breaking down. A convergence of contentious issues, as well as embarrassing infighting and shake-ups at the White House, have a number of Republicans suddenly in open resistance to President Trump on a number of fronts.

The most dramatic moment came in the early-morning hours Friday, when Sen. John McCain, an ailing war hero and onetime Republican presidential standard-bearer, joined two other GOP dissidents, Sens. Lisa Murkowski of Alaska and Susan Collins of Maine, to cast the deciding vote to kill a scaled-back plan to dismantle tenets of the Affordable Care Act and with it, perhaps, Trumps promise to repeal Obamacare.

But the signs of resistance went further.

Nearly every Republican in Congress voted with Democrats this week to approve legislation tying the presidents hands on a major foreign policy issue, making it harder for him to ease sanctions against Russia amid lawmakers concerns about Trumps friendly posture toward Russian President Vladimir Putin. Late Friday, the White House put out a statement saying Trump would sign the legislation; his veto would have been easily overridden.

Since Wednesday, some of the most conservative Republicans in Congress, as well as the Joint Chiefs of Staff, have pushed back at Trumps surprise announcement on Twitter of a ban on transgender people in the military. The critics, including McCain, who is chairman of the Senate Armed Services Committee, and an array of conservative senators, objected both to the substance of the ban which threatened the status of thousands of active-duty service members and to the way in which it was unveiled.

Perhaps the most broad opposition came in response to Trumps continued public humiliation of his attorney general, Jeff Sessions. Conservatives from Congress whod served with Sessions when he was in the Senate, delivered clear messages to Trump in Sessions defense in the media and throughout the country.

Sen. Lindsey Graham of South Carolina said Trump would have holy hell to pay if he fired Sessions, and Sen. Charles E. Grassley of Iowa, chairman of the Senate Judiciary Committee, warned that he would refuse to hold hearings this year to confirm a new attorney general.

Graham went further, saying that should Trump try to dismiss Robert S. Mueller III, the special counsel investigating potential Trump campaign collusion with Russia and obstruction of justice, it could spell the beginning of the end of the Trump presidency.

What hes interjecting is turning democracy upside down, Graham told reporters, adding that he was considering legislation to prevent Trump from dismissing Mueller and shutting down the Russia investigation.

Political veterans and Republican critics say Trumps seeming inability to focus on his policy agenda, amid the distractions of investigations, media baiting and staff dysfunction, leave him little leverage with Congress. Beyond that, his threats against some Republicans and shows of disloyalty toward allies like Sessions give lawmakers little faith that Trump will back them if they need political cover for tough votes.

Trumps approval rating is in the 30s, he uses his bully pulpit to beat up on staff and hes got no policy agenda, said Rory Cooper, a former Republican leadership aide and George W. Bush administration official who has been a Trump critic.

President Trumps closing argument on healthcare was that his staff and attorney general are not trusted, Cooper added. Its clear that members of Congress have no support or leadership from the White House.

Many conservatives had been willing to put up with Trumps erratic governance in the hopes he could at least deliver on longstanding conservative priorities. But Fridays defeat on the healthcare measure, after Republicans seven years of promises to repeal Obamacare, left many despairing that other promises, especially on a tax overhaul, could be imperiled.

"The president told everyone that only he could do the job and he would drain the swamp, wrote Erick Erickson, an influential conservative radio host and blogger. Instead, hes dammed up the swamp, put a party boat on it, and has turned his attention to Twitter."

Trump, as he often does, blamed Democrats. But he upbraided Republicans as well on Friday, both on Twitter and during a Long Island speech that was supposed to be about cracking down on criminal gangs.

"They should have approved healthcare last night, but you can't have everything, Trump said in New York. They've been working on that for seven years. Can you believe that? But we'll get it done. I said from the beginning, let Obamacare implode and then do it."

Individual Republican lawmakers have walked a careful line with Trump throughout his first six months siding with him on many issues and withholding criticism on others, while disagreeing at times to show their independence, especially in opposition to Trumps proposed deep cuts in domestic and international aid programs.

But the healthcare bill proved more complicated to navigate. Polls showed that Republican efforts at repeal were widely unpopular, including among some conservatives, and prominent Republican governors were strongly opposed. Yet the party had promised repeal and replace since 2010.

John Weaver, a former longtime political consultant to McCain, said of the senators break with Trump on the healthcare bill, after two earlier votes in support, I dont think he took any joy in it.

But, Weaver said, I think he wanted to send a clear signal that whats happening in the White House is not normal and whats happening in the Congress is not normal.

Republican critics accuse Trump and his administration officials of combining arrogance with ineptitude, especially in how they carried out threats to wavering senators such as Murkowski and Nevada Sen. Dean Heller. Murkowski suggested to reporters that Interior Secretary Ryan Zinke threatened federal funding to her state, which is heavily dependent on it.

The Murkowski threat was particularly striking, because she is chairwoman of the Senate Energy and Natural Resources Committee, which oversees Zinkes department. Murkowski held fast.

Who ever heard of a Cabinet secretary threatening the chairman of the oversight committee of his department? Weaver said. Its like Dumb and Dumber merged with The Godfather here.

Still, Trump has hardly lost his ability to work with his party. Many in Congress continue to fear his ability to stir their most passionate partisans who continue to back him strongly and to encourage primary challenges for their seats.

Also, Trumps allies in outside groups already have shown a willingness to spend money on political advertising against wayward Republicans. A pro-Trump group ran ads against Heller in June, during an earlier stage of the healthcare effort, though it pulled them after objections from Senate Majority Leader Mitch McConnell.

But a Republican strategist with close ties to the White House, speaking on the condition of anonymity to describe internal discussions, said that weapon would be back on the table for the 2018 congressional election campaigns.

At the least, Trumps hold on the GOPs base could protect him against threats posed by the Russia investigations by Mueller and the congressional committees. But Trump is seeing that it would not be easy to thwart Muellers investigation by firing Sessions and getting his replacement to eliminate Mueller.

Republican senators have their guard up generally against presidential recess appointments, which allow presidents to fill jobs temporarily without Senate confirmation. If both parties agree, a senator will stay in town on a rotating basis to technically avoid having the Senate in recess.

Republicans did that to prevent President Obama from avoiding Senate confirmations and filling vacancies with recess appointments. But now they have signaled they are not willing to let Trump undercut their authority either.

Times staff writer Lisa Mascaro contributed to this report.

noah.bierman@latimes.com brian.bennett@latimes.com

Twitter: @ByBrianBennett, @noahbierman

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McCain's Obamacare vote isn't the only sign of GOP resistance to Trump - Los Angeles Times

President Trump tweeted out that his former Homeland Security Secretary John F. Kelly is replacing Reince Priebus as White House chief of staff on July 28. (Victoria Walker,Peter Stevenson/The Washington Post)

President Trump is not happy with the way his presidency is going. That much has become clear over the past few weeks. Hes shaken up his personal legal team, completely upended his communications team by installing a guy whos threatening to fire/killstaffers, and now hes ousted his chief of staff, Reince Priebus.

Trump announced Friday afternoon that he is replacing Priebus with retired Gen.John Kelly, currently the homeland security secretary.

Withevery staff move, Trump seems to be moving ever further away from the Republican establishment and building a much more insular team that fits his narrow worldview. Nowhere is this more evident thanin the Priebus-Kelly switch.

Kelly isnt a traditional choice for such a political job. Hes a retired Marine Corps general who has expressed no nuance about the war on terrorism. He has described terrorists as a savage enemyand publicly clashed with former president Barack Obama on whether to close Guantanamo Bay.

Kelly and Trump dont agree on everything. During his confirmation hearing, Kelly distanced himself from Trumps border wall (a physical barrier in and of itself will not do the job) and torture (Absolutely not, he said about whether he would carry out a hypothetical Trump order to bring back waterboarding.) The Senate approved him 88-11, with all Republicans voting for his nomination.

By contrast, Priebus is the very definition of the Republican establishment. He ran the Republican National Committee during the election. Hes buddies with that other Republican establishment figure, House Speaker Paul D. Ryan (R-Wis.) theyre both from Wisconsin and has been a GOP operative for years.

Actually, its not much of an overstatement to say that Priebus, along with Vice President Pence, was Trumps connection to Capitol Hill insiders. On Thursday, Ryan defended Priebus: Reince is doing a fantastic job at the White House, and I believe he has the president's confidence.

Smoothing Trumps relationship with the establishment was arguably the reason Trump picked Priebus in the first place. It was an olive branch to the very people he had assailed on the campaign trail, as The Washington Post reported at the time.

No more olive branches, it seems. Sean Spicer, another Republican establishment figure, is out after Trump hired New York financier Anthony Scaramucci as White House communications director.

Trump hasnt completely severed his ties with Congress. Key GOP lawmakers didnt outright criticize the staffing change, and some applauded Kellys promotion.

Secretary Kelly is one of the strongest and most natural leaders Ive ever known, said Sen. Lindsey O. Graham (R-S.C.) in a statement.

I congratulate Secretary Kelly on his appointment and look forward to working with him to advance our agenda, said Ryan, after devoting a paragraph to singing Priebuss praises.

Priebuss dismissal is also an admission by the president of how tumultuous these first six-plus months have been. Trump has yet to have a major policy victory. Hes under investigation by a special counsel for potential obstruction of justice. His team cannot get out from under a barrage of Russia-connection revelations. His approval rating is the lowest any modern president has had at this point in his tenure (36 percent, according to the latest Washington Post-ABC News poll). His relationship with Congress is fraught and hasnt been fruitful.

No!! replied Robert David Johnson, a presidential scholar at Brooklyn College, to my email asking whether any other presidency has experienced this much staffing turmoil in its first few months. Bill Clinton had some inexperienced staffers who left their job early on, and Lyndon B. Johnson had a lot of palace intrigue. Its almost as if Trump has managed to combine the two inexperience andlack of knowledge about Washington from Clinton with the palace intrigue of early LBJ, he said.

Trump clearly hasnt liked the results. Hestried to play nice with the Republican Party establishment and appears to have concluded that is what has plagued his presidency.

Read more:
With Priebus out, Trump moves still further away from the Republican establishment - Washington Post

Congressional Republicans on Friday glumly confronted the wreckage of their seven-year quest to abolish the Affordable Care Act, blaming each other and President Trump for the dramatic early-morning collapse of the effort but finding no consensus on a way forward.

Some GOP lawmakers clung to long-shot hopes that some version of the legislation might be revived and that a deal might yet be struck before the fall. But the Senates rejection early Friday of a last-ditch, bare-bones proposal to roll back just a few key planks of the law left GOP leaders with few options for uniting their sharply polarized ranks.

Hours later, House Republicans gathered in the Capitol to take stock of the situation. Some raised the prospect of abandoning their long-standing pledge to repeal and replace the ACA and instead working with Democrats to shore up weak spots in the law known as Obamacare. But Trump signaled little interest in that approach, leaving many lawmakers baffled about how to proceed.

Im not a prophet, said Rep. Tom MacArthur (R-N.J.), who helped push an earlier version of the repeal bill through the House. I dont know what comes next.

Politically, the collapse of the repeal effort is potentially devastating for Republicans. It leaves Trump without a significant policy achievement in the critical first six months of his presidency; it casts a pall over the partys coming drives to pass a budget and overhaul the tax code; and it exposes GOP lawmakers to rising anger from their conservative base.

Substantively, it leaves much work undone. While the ACA has made health insurance accessible to millions of Americans, it has failed to contain rising costs, especially in the individual insurance market, where people without access to employer-provided coverage buy policies. Without federal action and additional cash those marketplaces could become unstable.

Lawmakers in both parties have called for stabilizing the marketplaces. But many Republicans have little appetite for entering negotiations on the issue with Democrats.

I dont think the Democrats have any interest in doing anything productive, said Sen. Ted Cruz (R-Tex.), a vehement critic of the ACA. He added: Republican senators are going to go home. Theyre going to hear from their constituents, and I dont expect the response to be muted.

At the meeting of House Republicans, Speaker Paul D. Ryan (R-Wis.) summed up the mood by citing an old Gordon Lightfoot tune called The Wreck of the Edmund Fitzgerald, about sailors drowning on a sinking ship.

Entering and exiting the meeting, lawmakers offered a variety of ideas for addressing their predicament, and excuses for how they got here.

We just ran out of time. It was an artificial deadline, said Rep. Mark Meadows (R-N.C.), chairman of the hard-right Freedom Caucus. He predicted that Republicans would still get a bill to Trumps desk in September.

Other Republicans called on their colleague to start over and work with Democrats through the regular committee process to craft an ACA overhaul that could win bipartisan support.

A key leader of the GOP repeal effort, Rep. Greg Walden (R-Ore.), said he is willing to take that approach. And Sen. John McCain (R-Ariz.), the man credited with driving a stake through the heart of the latest GOP health measure, issued a rousing call to bipartisanship.

The vote last night presents the Senate with an opportunity to start fresh, McCain said in a statement. It is now time to return to regular order with input from all of our members Republicans and Democrats and bring a bill to the floor of the Senate for amendment and debate.

Democrats, too, expressed interest in working across the aisle, especially on a plan to make federal cost-sharing subsidies permanent. The subsidies which will total about $7billion this year and $10billion in 2018 reimburse insurers for reducing co-payments and deductibles for certain low-income customers, reducing their out-of-pocket costs.

Trump administration officials have yet to say whether they will continue financing the subsidies past the end of this month.

On Friday, Senate Minority Leader Charles E. Schumer (D-N.Y.) said he spoke with Ryan about that and other potential areas of cooperation.

The insurance industry, hardly our allies, have said the number one thing to stabilize the system and bring premiums down is to make the cost-sharing permanent, Schumer said. That would have a lot of support.

Schumer expressed hope that Fridays health-care vote would prove to be a magic moment that sparked a wave of bipartisanship. But Senate Majority Leader Mitch McConnell (R-Ky.) sent early signals that he is skeptical of requests for more federal money to shore up the ACA. After Fridays vote failed, McConnell stood red-faced and dejected on the Senate floor.

Now I think its appropriate to ask, what are their ideas? McConnell challenged Democrats. Itll be interesting to see what they suggest as the way forward. For myself I can say and I bet Im pretty safe in saying for most on this side of the aisle that bailing out insurance companies with no thought of any kind of reform is not something I want to be part of.

Trump, meanwhile, continued to express mainly hostility toward the ACA. On Friday, he unleashed a series of tweets blaming 3 Republicans and 48 Democrats in the Senate who let the American people down by rejecting the latest overhaul proposal.

As I said from the beginning, let ObamaCare implode, then deal. Watch! Trump wrote. He also called for Senate Republicans to abolish the filibuster a venerable Senate procedure designed to protect the minority party that requires contentious matters to receive the votes of at least 60 senators.

As Republicans weighed working with Democrats, they were also struggling to resolve hard feelings toward one another.

Rep. Mo Brooks (R-Ala.), who is running for Senate, placed primary responsibility for the failureof Fridays vote on McConnell. Rep. Charlie Dent (R-Pa.) blamed Trump, saying the president never really laid out core principles and didnt sell them to the American people.

Rep. Steve King (R-Iowa) issued a combative statement criticizing McCain and Sen. Lisa Murkowski (R-Alaska), who also voted no Friday.

King accused Murkowski of waging a successful write-in reelection campaign in 2010 that was essentially a revolt against GOP primary voters. And he said McCain recently told the Senate he would return and give all of you cause to regret the nice things you said about me. He kept his word.

Earlier this week, McCain, who was recently diagnosed with an aggressive form of brain cancer, flew to Washington and cast a vote that helped his colleagues begin debate on the latest GOP proposal to overhaul Obamacare. On Tuesday, he delivered a stirring address calling for a bipartisan approach to overhauling the 2010 health-care law and criticizing the highly secretive and partisan process that had produced the pending legislation.

The speech set the stage for what was to come.

In the wee hours after midnight Friday, McCain scarred from recent surgery to remove a blood clot that unearthed his cancer rebuffed a last-minute appeal from Vice President Pence on the Senate floor. He emerged from his talks with Pence at 1:29a.m., approached the Senate clerk and gave a thumbs down joining Murkowski and Sen. Susan Collins of Maine as the only Republicans to vote against the legislation.

The measure failed, 51 to 49, with all 48 members of the Democratic caucus voting no.

Stunned gasps and some applause echoed through the chamber. McConnell and his leadership aides stood nearby, grim-faced and despondent.

Maybe this had to happen to actually begin to have a conversation, said Sen. Bill Cassidy (R-La.), who had tried and failed to broker a bipartisan compromise. The president challenged us to replace, not just repeal. And so once you decide that you want to replace, not just repeal, it becomes more difficult.

On Friday, Sen. Bill Nelson (D-Fla.) said he and Collins were working on a new bipartisan health plan. Sen. Joe Manchin III (D-W.Va.), a centrist facing reelection, said he met Wednesday night with 10 other senators and were going to keep talking.

Meanwhile, McCains office announced Friday afternoon that he would fly back to Arizona for radiation and chemotherapy on Monday, but that he would be back in Washington in the fall.

But while talk of bipartisanship was ascendant in the Senate, many House members were angry with their Senate colleagues for letting the repeal effort fail.

Outside Fridays House GOP meeting, Rep. David Schweikert (R-Ariz.) told an old joke shared around the Capitol to illustrate the tensions.

Youre a brand-new member and the guys all pop down next to you and say, See across the hall, thats your opposition. The other side of the Capitol, thats the enemy, Schweikert said. Turns out it could be true.

Juliet Eilperin, Paul Kane and David Weigel contributed to this report.

Read more:
Republican divided on whom to blame for health-care defeat, and what to do next - Washington Post

More than half of Californias 14 House Republicans face potentially tough battles in next years midterm election, and while some of them wavered until the last minute, all of them voted for the House healthcare plan in May.

But in the wee hours of Friday morning, the Senate failed in its apparent last-ditch effort to pass any kind of replacement for Obamacare.

For now, it looks as if congressional leaders are moving on from their healthcare reform efforts, but the Californians vote for a plan that would have taken health insurance from as many as 1 in 3 Californians is sure to be kept alive by the dozens of challengers who have signed up to run against them.

Democrats are plotting to use the healthcare vote as a cudgel against vulnerable Republicans in the same way votes for Obamacare were used to sweep Democrats out of the majority in 2010. And winning at least some of California's GOP seats is crucial to Democratic efforts to win back the House.

The party blasted out news releases Friday saying the representatives "can't turn back time and undo the damaging vote they took to kick 23 million Americans off their health insurance and jack up premiums for millions more. ... [They] own the Republican health care disaster and it will haunt them in 2018."

At the time of the House vote, several of Californias Republican representatives said they were keeping their years-long promise to repeal President Obamas signature law. Others said they were trying to move the process forward with the expectation the Senate would make the bill better.

Now they say they're disappointed the Senate couldn't agree on a way to repeal Obamacare, but none is too concerned about the political effects of voting for the House version, which polls have shown was very unpopular.

Rep. Jeff Denham of Turlock initially said he couldnt back the House bill, but voted for it after getting a commitment from GOP leaders to work on access to healthcare, especially in rural areas. He said Friday he was frustrated the Senate couldnt pass anything.

I expect to see this place work," Denham said. Im certainly disappointed that they werent able to move the ball forward."

Sarah D. Wire

Here's how the Republicans of California voted on the House bill to replace Obamacare.

Here's how the Republicans of California voted on the House bill to replace Obamacare. (Sarah D. Wire)

Hours before the Senate's failed vote, Denham held a campaign fundraiser in Washington for his 50th birthday with top House leaders. Denham has drawn at least eight opponents in a district where hes frequently challenged, but said he wasnt worried about being attacked for his healthcare vote.

Yes, [House Minority Leader] Nancy Pelosi will always target me and we will continue to focus on our district issues, and I think when I do that weve been very successful by a wide margin, Denham said. I certainly dont vote because Nancy Pelosi sends people into my district; I focus on my district.

Denham said he expects to meet with doctors, hospitals and patients during the August recess to talk about other potential healthcare legislation.

He and fellow vulnerable Central Valley Republican Rep. David Valadao of Hanford introduced legislation this week to increase the number of doctor training positions available in areas with high Medicaid populations, something that fits the description of their rural districts, where residents saw some of the biggest benefits from the Medi-Cal expansion under the Affordable Care Act.

Valadao said he was disappointed by the Senate's failure, and believes Republicans still have an obligation to do something about Obamacare.

We do have to have some legislation move forward, he said. Hopefully well get an opportunity to get something done soon.

Prior to the House vote, Rep. Darrell Issa of Vista had said the bill could be improved and he was on the fence about how to vote. Hed barely scraped out a win last year by fewer than 2,000 votes, and more opponents were lining up to challenge him again.

He said he ultimately voted for it because he had faith the Senate would send back a better bill. Issa even nudged Senate leadership twice to consider his idea to offer federal employees healthcare plans to more or all Americans. He said in a statement Friday that hell keep pushing colleagues on that idea.

"Its disappointing, but we cant give up now. Obamacare is still failing and we must bring young adults, families, small business and all Americans relief. We need to keep up the fight," he said.

Rep. Steve Knight of Palmdale, the last Republican congressman in Los Angeles County, said the House had done its part and its still up to the Senate to decide what happens next. Asked about the political ramifications of his vote, he laughed.

Democrats targeted my district way before any vote I made, said Knight, who was among the members expected to be greeted by planned healthcare protests in their hometowns as the House embarked on a monthlong recess Friday. This was a very difficult vote, everybody knows that, but were going to move forward.

Rep. Doug LaMalfa (R-Richvale), whose Northern California seat is not considered to be at risk, said members should confidently explain their positions to voters.

Were here to make hard votes, [we]re here to make votes of conscience. Some guys and gals will complain, Oh, now were out on record with a hard vote you know the guys in the tougher districts but at the end of it, you have a reason that you are supposed to be here, LaMalfa said. If you cant justify your position outside the politics, then why are you here?

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California's House Republicans voted for the Obamacare repeal that seems dead. Here's what they're saying now - Los Angeles Times