In the early hours of the morning on July 28, 2017, the Senate held its final vote on Republican efforts to repeal and replace the Affordable Care Act (ACA). The Health Care Freedom Act, referred to by some as “skinny repeal,” fell 51-49, with Republican Senators John McCain (R-AZ), Lisa Murkowski (R-AK), and Susan Collins (R-ME) joining all Democrats in voting against the bill.
The path towards repeal in the Senate had been winding at best. After multiple delays, the Senate narrowly voted to proceed to debate on the House version of the bill, the American Health Care Act (H.R. 1628). Sens. Murkowski and Collins were opposed to the motion, requiring Vice President Mike Pence to provide the tiebreaking vote. The Senate then considered several different options on the repeal efforts, which were all defeated. Senate Republican’s own original plan, the Better Care Reconciliation Act, was soundly defeated, with 9 Republicans from the conservative and moderate wings voting against (57-43).
[Republicans voting against the BCRA were Susan Collins, Lisa Murkowski, Bob Corker (TN), Tom Cotton (AR), Lindsey Graham (SC), Dean Heller (NV), Mike Lee (UT), Jerry Moran (KS), and Rand Paul (KY)]
Next, Senate Majority Leader Mitch McConnell brought up a partial repeal bill, the Obamacare Repeal and Reconciliation Act, which would have repealed essential ACA provisions like the individual mandate, Medicaid expansion, and premium subsidies after a period of two years, during which the Senate hoped to draft a replacement plan. This was voted down 55-45, with Sens. Collins, Murkowski, Heller, McCain, Shelley Moore Capito (R-WV), Rob Portman (R-OH), and Lamar Alexander (R-TN) voting against.
The “skinny repeal” bill was brought up as a last-ditch effort to garner consensus from the Republican caucus on repeal efforts, with the intention of passing a bare-bones bill in order to come up with a fuller plan in conference with the House of Representatives. It would have repealed selected provisions of the ACA, including the individual mandate, delay the employer mandate until 2025, extend the moratorium on the medical device excise tax through December 31, 2020, and modify ACA State Innovation Waivers, among other provisions. For the moment, Republican efforts to repeal the ACA are dead, and Senate leadership has expressed a desire to move onto other business. However, some House Republicans, including Rep. Tom MacArthur (R-NJ), Greg Walden (R-OR) and Freedom Caucus Chairman Mark Meadows (R-NC) have stated they will continue in their efforts to take down the ACA.