President Donald Trump called on Senate Republicans to start the process of repealing the Affordable Care Act, warning that anyone who votes not to take up the bill Tuesday is saying they are “fine with the Obamacare nightmare.”

“For Senate Republicans this is their chance to keep their promise,” Trump said at the White House on Monday. “There has been enough talk and no action. Now is the time for action.

(Related: Senate Parliamentarian Zaps Some Better Care Bill Provisions)

Senate Republican leaders must decide which health care proposal they’ll ask members to vote on this week, in what has become a series of all-out efforts to get their own members on board.

“It’s my understanding that the leadership is going to meet tonight and decide,” said Republican Sen. Susan Collins of Maine, one of the principal holdouts from the party’s proposals thus far to replace — or perhaps only repeal — the Affordable Care Act. “So I don’t know,” she said in an interview Monday.

Sen. Pat Roberts of Kansas, a GOP member of the Health committee, said senators are discussing revisions to Majority Leader Mitch McConnell’s plan to change the Affordable Care Act, which collapsed for lack of support last week. The majority leader then said he would seek to bring a simple repeal of many Affordable Care Act tax and spending provisions to the floor early this week, but that proposal also fell apart amid opposition from Collins and others.

“It’s still fluid,” said Roberts, who added that he wants to support whatever plan emerges because he opposes leaving the Affordable Care Act in place.

Republicans are struggling for a way to fulfill years of promises by party leaders to get rid of Affordable Care Act. They’ve been unable to find a replacement plan that can attract at least 50 votes in the Senate, where the party has a 52-48 majority. McConnell is trying to coax support from moderate and conservative Republicans who have raised objections amid unified Democratic opposition.

Second-ranking Senate Republican John Cornyn of Texas said Monday that the GOP won’t give up on an Affordable Care Act change bill if the Senate can’t pass it this week. “If for some reason we aren’t able to muster the votes tomorrow, which I’m increasingly optimistic we will, it’s not the end of it,” he said.

Sen. John Barrasso of Wyoming, a member of the GOP leadership team, said Sunday on CBS’s “Face the Nation” that the plan on Tuesday is to hold a procedural vote on whether to bring the House-passed health bill to the floor.

Then, senators could “amend it in various ways and lots of members have different ideas on how it should be best amended,” Barrasso said. “Until the vote is actually on the floor of the Senate, some people may not tell you what they’re actually going to do.”

Collins and West Virginia Senator Shelley Moore Capito have said they oppose any plan that doesn’t include an adequate replacement for the current Affordable Care Act health coverage programs. On the other end of the GOP’s ideological spectrum, Sen. Rand Paul of Kentucky wants legislation that more fully repeals the Affordable Care Act.

Seema Verma (Photo: Senate)

Seema Verma (Photo: Senate)

Roberts said his main concern is the effect of spending cuts on rural hospitals that get Medicaid funds. “Under the current system, they’re just not going to be able to make it,” Roberts said. “We’ve just got to figure out a way to make that work better.”

He said he was in touch over the weekend with Seema Verma, the Trump administration’s head of Centers for Medicare and Medicaid Services (CMS), and that her proposal to make up some funding with non-Medicaid money has potential.

It will be hard to get people who have taken hard stands against McConnell’s plan or portions of it to change their positions, Roberts said.

“It’s awfully difficult when people climb the tree and get out on a limb and say, ‘I’m going to vote no,”’ the Kansas senator said. “For them to skinny back down that tree, that’s tough. And they have to have some very good reasons as to why that’s the case.”

‘Disastrous ObamaCare’

Trump has alternated between calling on lawmakers to let Obamacare die and insisting that Republicans come up with a replacement plan. Late Sunday, he wrote on Twitter: “If Republicans don’t Repeal and Replace the disastrous ObamaCare, the repercussions will be far greater than any of them understand!”

One difficulty for the GOP is Arizona Sen. John McCain’s brain-cancer diagnosis last week. He has said he wants to return to Washington as soon as he can, though he hasn’t given a timetable.

Collins said Monday it’s unclear whether a health care measure can survive a procedural vote without McCain.

“I don’t know, and I don’t know whether or not Senator McCain is going to be here. I talked with him over the weekend, and it was uncertain,” she said.

Efforts to resurrect McConnell’s Affordable Care Act change bill suffered a further blow on Friday when the Senate parliamentarian issued a preliminary finding that key parts of the proposal don’t qualify for a fast-track procedure being used by the GOP. Those parts would require 60 votes rather than the simple majority the GOP seeks to use, Parliamentarian Elizabeth MacDonough said.

Among them are provisions that would defund Planned Parenthood for a year, prevent tax credits from being used to buy insurance policies that cover abortion, and encourage people to have continuous insurance by barring those without coverage for at least two months from buying new insurance for half a year.

—With assistance from Alexander Ruoff.

— Read New White House Comm Chief Scaramucci Supports Trump’s Tweets  on ThinkAdvisor.

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