WASHINGTON — House Republican leaders, facing a revolt among conservatives and moderates in their ranks, pulled legislation to repeal the Affordable Care Act from consideration on the House floor Friday afternoon in a humiliating defeat for President Trump on the first legislative showdown of his presidency.
Paul D. Ryan, the House speaker, rushed to the White House shortly after noon to tell Mr. Trump he did not have the votes for a repeal bill that had been promised for seven years — since the day President Barack Obama signed his landmark health care act into law.
Vice President Mike Pence and Tom Price, the health secretary, rushed to Capitol Hill for a late appeal to House conservatives, but their pleas fell on deaf ears.
“You can’t pretend and say this is a win for us,” said Representative Mark Walker, Republican of North Carolina, who conceded it was a “good moment” for Democrats.
“Probably that champagne that wasn’t popped back in November may be utilized this evening,” he said.
The Republican bill would have replaced the Affordable Care Act, known informally as Obamacare, which mandated that almost everyone have health insurance, with a system of age-based tax credits to purchase health insurance plans.
But it never won over conservatives who wanted a far more thorough eradication of the Affordable Care Act. Nor did it have the backing of more moderate Republicans who were anxiously aware of the Congressional Budget Office’s assessment that the bill would leave 24 million more Americans without insurance.
With the House’s most hard-line conservatives holding fast against it, the bill’s support collapsed Friday after more rank-and-file Republicans came out in opposition, including Representatives Rodney Frelinghuysen of New Jersey, the soft-spoken chairman of the House Appropriations Committee, and Barbara Comstock of Virginia, whose suburban Washington district went handily for the Democrat nominee, Hillary Clinton, in November.
“Seven years after enactment of Obamacare, I wanted to support legislation that made positive changes to rescue health care in America,” he wrote in a statement. “Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey.”
In the end, Republican leaders doomed the bill by agreeing to eliminate federal standards for the minimum benefits that must be provided by certain health insurance policies.
“This provision is so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret capitol lair last night,” said Representative Jim McGovern, Democrat of Massachusetts. “This backroom deal will kill the requirement for insurance companies to offer essential health benefits such as emergency services, maternity care, mental health care, substance addiction treatment, pediatric services, prescription drugs and many other basic essential services.”
Defeat of the bill could be a catalyst if it forces Republicans and Democrats to work together to improve the Affordable Care Act, which virtually every member of Congress believes needs repair. Democrats have been saying for weeks that they want to work with Republicans on such changes, but first, they said, Republicans had to abandon their drive to repeal the law.
President Trump, through his budget director, Mick Mulvaney, told House Republicans on Thursday night that he was giving them this one chance to repeal the Affordable Care Act. If they failed, Mr. Mulvaney told them, the president would live with his predecessor’s law.
Rejection of the repeal bill may also prompt Republicans to reconsider the political strategy they were planning to use for the next few years.
“We have to do some soul-searching internally to determine whether or not we are even capable of functioning as a governing body,” said Representative Kevin Cramer, Republican of North Dakota. “If ‘no’ is your goal, it’s the easiest goal in the world to reach.”
Representative Robert Pittenger, Republican of North Carolina, offered this advice to hardline conservatives who helped sink the bill: “Follow the example of Ronald Reagan. He was a master, he built consensus. He would say, ‘I’ll take 80 percent and come back for the other 20 percent later.’”
Failure of the House effort leaves the Affordable Care Act in place, with all the features Republicans detest.
The Republican bill would have repealed tax penalties for people who go without health insurance, rolled back federal insurance standards, reduced subsidies for the purchase of private insurance and set new limits on spending for Medicaid, the federal-state program for more than 70 million low-income people. The bill would also have repealed taxes imposed by the Affordable Care Act on health insurance providers, manufacturers of prescription drugs and medical devices, and many high-income people.
The bill would also have cut off federal funds to Planned Parenthood for one year.
Mr. Ryan said the bill included “huge conservative wins.” But those provisions were ultimately not enough.