Down In Flames / Mike Schmid

July 27th, 2017; New York Times

Senators John McCain of Arizona, Susan Collins of Maine, and Lisa Murkowski of Alaska were the Republicans who cast the deciding votes against the so-called “skinny” version of a bill that would have repealed the Affordable Care Act (ACA). Collins and Murkowski were expected to oppose the bill, but suspense hung over the Senate floor early Friday morning as McCain held a 20-minute conversation with Vice President Mike Pence and hung out with Democrats on the Senate floor. While the GOP murmured “trust us” to some recalcitrant senators, promising that the House would not pass it anyway, the president was tweeting “Go Republican Senators, Go!” and health insurance coverage for an estimated 16 million Americans hung in the balance. In the end, however, the no votes came from exactly where it could have been predicted they would.

In the end, senators did not, as Lindsay Graham of South Carolina said, want to vote for a “pig in a poke” simply for the exercise of passing something at the insistence of the president. As the New York Times explained,

There’s the question of what would come next. Republican leaders are assuring senators that the narrow repeal would be merely a vehicle to begin negotiations with House Republicans on a broader compromise to repeal and replace the Affordable Care Act. But some senators worry that they are being asked to vote for legislation they don’t like on a promise that it won’t become law—but they have no guarantee that the House won’t take it up and pass it.

And in the end, the vague nonbinding assurances were insufficient.

Industry associations like the American Medical Association (AMA) and AARP emphatically opposed it, with the AMA writing:

There has been considerable speculation regarding a so-called ‘skinny package’ that would primarily eliminate penalties related to the individual and employer mandates and provide tax cuts to device manufactures and the health insurance industry. Eliminating the mandate to obtain coverage only exacerbates the affordability problem that critics say they want to address. Instead, it leads to adverse selection that would increase premiums and destabilize the individual market.

We again urge the Senate to engage in a bipartisan process – through regular order – to address the shortcomings of the Affordable Care Act and achieve the goal of providing access to quality, affordable health care coverage to more Americans.

AARP, which reminded Congress in the first sentence of its letter that it has 38 million members, was just as clear in its opposition.

But—is it over? After the vote, Trump tweeted,

3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!

After the vote, Senate Majority Leader Mitch McConnell (R-KY) said, “This is clearly a disappointing moment. I regret that our efforts were simply not enough—this time.”—Ruth McCambridge