President Donald Trump speaks at a campaign rally in Grand Rapids, Michigan, March 28, 2019. Credit: Manuel Balce Ceneta | AP

President Donald Trump’s renewed fixation on repealing and replacing Obamacare took another bewildering turn late Monday night, as he promised Republicans would pass a “truly great” health-care plan after they supposedly win back the House and hold on to the Senate in November 2020.

It’s almost as if someone at the White House finally convinced Trump there’s zero chance of Republicans repealing the Affordable Care Act while Democrats control the House. But even if Trump’s prediction comes true — and Republicans once again control both chambers of Congress (and Trump wins re-election) — it’s not at all clear they’d be able to agree on a repeal-and-replace bill.

None of these realities have stopped Trump from firing off a series of anti-Obamacare tweets over the past week. Invigorated by the Russia investigation’s findings, Trump has resumed calls for Congress to repeal Obamacare, pouring pressure on several senators he’s asked to lead an effort. He has repeatedly named three Republican senators – John Barrasso of Wyoming, Bill Cassidy of Louisiana and Rick Scott of Florida – as the leaders on crafting an Obamacare replacement.

Barrasso and Cassidy are both physicians, while Scott is a former hospital executive – perhaps indicators of Trump’s decision to name them directly.

Only a handful of members of Congress have responded positively to the president’s demands. Sen. Lindsey Graham, R-South Carolina, known for his friendship with Trump, issued a release Monday saying “Obamacare cannot be fixed. . .it must be replaced.” Rep. Mark Meadows, R-North Carolina, has told reporters he’s working on a replacement plan.

Rep. Bruce Westerman, R-Arkansas, has been shopping around a 200-page bill he introduced a few weeks ago that would revise the ACA but would also clamp down on hospital consolidation and mergers. Westerman’s communications director Rebekah Hoshiko sent out a plea last week to a listserv of GOP staff to have their bosses consider signing on.

“GOP does actually have viable options, so let’s combat Dems’ narrative,” Hoshiko wrote.

But McConnell has indicated he has no interest in trying again to repeal Obamacare. And the other three senators Trump mentioned in his tweet have stressed they’re focused on ways to lower health-care costs generally rather than try to scrap the health-care law.

Scott and the president spoke on the phone last week, according to spokesman Chris Hartline. But Hartline quickly added the senator’s focus is on driving down the cost of prescription drugs, pointing to a bill Scott released last week requiring insurers and pharmacies to give consumers more transparent pricing information.

“Sen. Scott is focused on what can get passed Congress this year, which is why his focus has been on lowering the cost of prescription drugs,” Hartline said.

Other members of Congress are more explicit in their refusals to participate in more Obamacare repeal-and-replace exercises – an effort bound to be fruitless partly due to a Democrat-led House.

“Not only is this a poor political move, this decision hurts real people who will unfairly lose their health insurance coverage as a result,” Rep. Tom Reed, R-New York, said in a statement to The Health 202. “We need to work to find ways to fix our health-care system – not blow it up.”

Democrats are delighted by the recent turn of events.

Tuesday morning, House Speaker Nancy Pelosi, D-California, and Senate Minority Leader Chuck Schumer, D-New York, were scheduled gather with other top Democrats on the steps of the Supreme Court, where they’ll introduce a resolution condemning the Trump administration for now refusing to defend any part of the ACA in a legal challenge brought by conservative-led states.

The Democratic-majority House may vote later today to pass the resolution, which calls the Justice Department’s position “an unacceptable assault on the health care of the American people,” as way of putting Republicans on the hook for either supporting or opposing a Trump administration decision many of them privately disagree with.

“We are going to put Republicans on record about where they stand with this latest assault,” a senior Democratic aide told The Health 202. “It will be interesting to see whether more Republicans break off.”

The House passed two measures back in January allowing its legal counsel to weigh in on the lawsuit and condemning the Justice Department’s position that the ACA’s protections for people with preexisting conditions should be struck down. Three Republicans, including Reed, John Katko of New York and Brian Fitzpatrick of Pennsylvania, voted with Democrats at the time.

But more Republicans may be willing to cross the aisle now that the administration has taken an even firmer stance against the ACA, saying last week that it agrees with a federal court ruling that the entire law should be invalidated. Reed said he will again vote with Democrats on their latest resolution criticizing the administration for refusing to defend the ACA.