The decisive vote to repeal and/or replace the Affordable Care Act (ACA) ended in an early-morning defeat for Republican opponents of the law, as three GOP senators—Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona—voted “no” on the so-called “skinny repeal” plan.
The bill they were voting on had been released only hours before, on Thursday, July 27. It would have eliminated the ACA’s individual mandate, wiped out the employer mandate until 2024, allowed for increased health savings accounts contributions, repealed the medical device tax and sped up HHS’s 1332 waiver process for “state innovation” strategies.
The result of what was called the Health Care Freedom Act, according to the Congressional Budget Office, would be 16 million fewer people with insurance coverage by 2026. The goal for Republicans, however, was not to have the bill signed into law as-is, but use it as a vehicle to open a conference committee with the House and craft a larger ACA replacement.
Murkowski and Collins had been the most likely no votes after being the only Republicans to vote against proceeding to debate on an ACA plan earlier in the week. McCain was the surprise, with Republicans holding the vote open to try and sway him to support it. According to multiple reports, Senate Majority Leader Mitch McConnell, Vice President Mike Pence and—via phone—President Donald Trump all failed to change McCain’s mind.
Just before 1:30 a.m., Friday morning, McCain walked up to the well of the Senate and signaled his vote with a thumbs-down.
“I thought it was right thing to do,” McCain said about his vote to reporters as he left the Capitol.
Days earlier, he had chastised his colleagues for how the repeal bill was crafted, even though he did vote to open debate on the legislation in returning to the Senate soon after being diagnosed with an aggressive form of brain cancer.
McConnell’s response after the vote was to blame Democrats, calling the result “a disappointment” to his caucus and challenging the minority party to “tell us what they have in mind.”
“Now I think it’s appropriate to ask, what are their ideas? It’ll be interesting to see what they suggest as the way forward,” McConnell said. “For myself I can say—and I bet I’m pretty safe in saying for most on this side of the aisle—that bailing out insurance companies with no thought of any kind of reform, is not something I want to be part of.”
Democratic leader Chuck Schumer of New York followed up with his own speech calling on both parties to “turn the page” and work together on fixes for the ACA. Among healthcare groups, almost all of which had opposed the various Senate repeal efforts, the sentiment was largely the same.
“While we are relieved that the Senate did not adopt legislation that would have harmed patients and critical safety net programs, the status quo is not acceptable,” American Medical Association President David Barbe, MD, said in a statement. “We urge Congress to initiate a bipartisan effort to address shortcomings in the Affordable Care Act. The first priority should be to stabilize the individual marketplace to achieve the goal of providing access to quality, affordable health coverage for more Americans.”