Senate Majority Leader Mitch McConnell employed an iron fist over the Republican health care effort, keeping top lieutenants in the dark about key decisions and withholding detailed policy information from the conference as a whole until just before it was released publicly.

Now with the seven-year effort to gut the 2010 health care law in tatters, it falls on the Kentucky Republican to deal with the aftermath, and quell concerns about whether he can continue to lead effectively. 

With no clear direction forward, the rest of the ambitious GOP agenda remains uncertain.

Republicans on Tuesday were largely noncommittal over what would come next, and several instead chose to continue to harp on the potential damage to the party if its long-held antipathy of the law does not yield measurable progress.

“We have to have the confidence of the American people that we can get things done. There will be millions of people who see significantly higher premiums because we haven’t been able to come to a consensus on this particular issue,” Sen. Mike Rounds of South Dakota said.

Strategy failings

“I continue to believe we can and will get this done,” Texas Sen. Ted Cruz said. “Every Republican for the last seven years has campaigned on repealing Obamacare. I think the credibility of the conference is seriously undermined if we fail to deliver on that promise.”

Questions also linger over what impact McConnell’s strategy — choosing to craft a bill largely behind closed doors and placing strict deadlines on his own members — has had on the morale of the GOP conference.

Sen. Ron Johnson, for example, declined to say on Tuesday whether he still trusts McConnell following the health care failure, citing assurances the majority leader made to moderate lawmakers that the GOP’s proposed cuts to Medicaid would never go into effect.

“I was very troubled with those comments,” the Wisconsin Republican said.

When asked whether McConnell is solely to blame for the failure, Johnson said, “I don’t know, who wrote the bill?”

And while the Senate Republican Conference tries to recover from a monumental defeat on the health care effort, President Donald Trump vowed to move forward with his plan to let the health care law collapse. 

“I think we’re probably in that position where we’ll let Obamacare fail,” he said. “We’re not going to own it. I’m not going to own it,” he said, despite the GOP locking Democrats out of the process. 

On Health Care, Where Do Republicans Go Now?

Repeal then delay?

Following Tuesday’s weekly Republican policy luncheon, McConnell said the chamber would hold a vote “sometime in the near future” on legislation from 2015 to repeal the health care law that was vetoed by President Barack Obama. The majority leader informed senators Tuesday that, at the request of the president and vice president, the vote would take place early next week.

“It’s pretty clear that there are not 50 Republicans at the moment to vote for a replacement for Obamacare,” he told reporters. “This has been a very, very challenging experience for all of us.”

But the vote on an initial procedural hurdle looks destined to fail. Three Republican senators have said they wouldn’t support the motion to proceed that would allow the 2015 repeal legislation to come up for a vote, enough to block it. 

What comes after that likely failure remains an open question, but McConnell’s top allies expect work to begin on a bipartisan health care bill.

“I suspect there will be discussions on a bipartisan bill,” Senate Majority Whip John Cornyn of Texas said. “To me, that’s unfortunate in a sense because I think the Democrats are strongly committed to Obamacare and are unwilling to admit the structural problems which create the problems we are having in the individual market today.”

And while the conference continues to try to chart a path forward, skeptical lawmakers are holding back any direct criticism.

“I don’t want to ascribe blame to anyone,” said Sen. Lisa Murkowski of Alaska, one of the three GOP senators who vowed to vote against the 2015 repeal bill. “I have long held that a committee process allows for a way to go forward that, while not easy, does allow for, typically, a product that has gone through greater vetting.”

Next moves

Senate Health, Education, Labor and Pensions Chairman Lamar Alexander, in a statement released on Tuesday, said his panel would soon turn to work on measures to shore up the insurance markets that have shown signs of turmoil.

“However the votes come out on the health care bill, the Senate health committee has a responsibility during the next few weeks to hold hearings to continue exploring how to stabilize the individual market. I will consult with Senate leadership and then I will set those hearings after the Senate votes on the health care bill,” the Tennessee Republican said.

Other members continue to try to push their respective proposals. Louisiana Sen. Bill Cassidy, for example, is still advocating for a bill he is working on alongside Sen. Lindsey Graham of South Carolina that would essentially give states a bulk amount of funding each year to manage their insurance systems.

“Obviously, leadership wants to know that there is an interest in this among everybody, so we are trying to develop that interest,” Cassidy said.

And despite a looming battle on the overhaul of the U.S. tax code that promises to be as difficult, if not more so, than the health care debate, Republican members are optimistic.

“At the end of the day, what we have to do is cobble together the votes to move forward on other issues. The reality of it is this is a setback, but it’s not, in my opinion, … an unexpected setback,” South Carolina Sen. Tim Scott said.

Andrew Siddons and John T. Bennett contributed to this report.