Why the Obamacare repeal effort is suddenly a huge mess

(J. Scott Applewhite / AP)

Despite Republican leaders' insistence that the Obamacare repeal effort is making steady progress, deep rifts have split the caucus. Hardliners in both the House and the Senate have threatened to oppose any repeal that isn't aggressive enough, which could kill the effort in both chambers if a bill loses either conservatives or moderates.

Perhaps the most irreconcilable issue among different factions is, of all things, Medicaid expansion. That was a big topic at Tuesday's Senate GOP caucus lunch, attended by both House Speaker Paul Ryan and Vice President Mike Pence. While Republicans from states that expanded Medicaid don't want to throw constituents off their coverage, others say it's not fair for their states to be penalized for not taking the expansion.

Another problem: While the House Freedom Caucus won't say it collectively opposes including pieces of a replacement in the repeal bill, it prefers a straight repeal — even though the leadership is already planning to include replacement. Some individual members in both chambers have said they're opposed to the replacement strategy, largely because it's slowing down the repeal process.

Put it all together and it's a tenuous path forward, at best. At worst, the repeal effort is falling apart.