Senate Republicans’ first attempt to repeal and replace the Affordable Care Act failed July 25 as nine Republican senators crossed the aisle to vote against a measure that had no chance of passing.

The process started with a dramatic appearance by Sen. John McCain (R-Ariz.), recovering from surgery to diagnose glioblastoma, who returned to Washington to cast a key vote that would allow debate to move forward. The Senate split 50-50 on that vote, with Sen. Susan Collins (R-Maine) and Sen. Lisa Murkowski (R-Alaska) crossing the aisle to vote with all the chamber’s Democrats against the motion to proceed. Vice President Mike Pence cast the tie-breaking vote in favor of beginning debate.

The bill under consideration was the Obamacare Repeal Reconciliation Act , which aimed to repeal the ACA by the end of 2019.

However, the first amendment voted on would have replaced that language with the most recent version of the Senate GOP repeal-and-replace plan, the Better Care Reconciliation Act , with two additional provisions. One was from Sen. Ted Cruz (R-Tex.) and would allow insurers to offer more limited health insurance plans along side plans that cover the ACA’s essential benefits package. A second provision from Sen. Rob Portman (R-Ohio) would have added an additional $100 billion to the state stability fund to help low-income individuals whose Medicaid coverage was repealed.

The amendment was dead on arrival, as it would have needed 60 votes to pass. Throughout the repeal-and-replace effort, the 48 Senate Democrats have been firm in voting against any action. While much of the repeal-and-replace effort to date has relied on the budget reconciliation process, which requires a simple majority for passage, this legislation did not qualify and needed a supermajority of 60 votes for passage.

The nine GOP senators voting against the amendment included Collins, Murkowski, Bob Corker (Tenn.), Tom Cotton (Ark.), Lindsey Graham (S.C.), Dena Heller (Nev.), Mike Lee (Utah), Jerry Moran (Kan.), and Rand Paul (Ky.).

Earlier in the day, just after voting in favor of action on this legislation, Sen. McCain pleaded with his colleagues to return to regular order and write a bill that has bipartisan support. He criticized congressional Democrats for forcing the ACA through without bipartisan support 7 years ago and congressional Republicans for doing the exact same thing now with their repeal-and-replace efforts.

“Why don’t we try the old way of legislating in the Senate, the way our rules and customs encourage us to act,” Sen. McCain asked. “Let the Health, Education, Labor, and Pensions Committee under Chairman Alexander and Ranking Member Murray hold hearings, try to report a bill out of committee with contributions from both sides. Then bring it to the floor for amendment and debate and see if we can pass something that will be imperfect, full of compromises, and not very pleasing to implacable partisans on either side but that might provide workable solutions to problems Americans are struggling with today.”

gtwachtman@frontlinemedcom.com

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