After a series of votes during the week of July 24, Senate Republicans failed to pass legislation that would repeal and replace the Affordable Care Act. The following is a summary of the votes that occurred during the week:

  • July 25: With Vice President Mike Pence serving as the tie-breaking vote, the Senate approved a procedural motion to open debate on repealing and replacing the ACA.
  • July 25: The Senate voted down, in a 43 to 57 vote, a modified version of the Senate GOP’s repeal and replace bill, the Better Care Reconciliation Act. This version included Sen. Ted Cruz’s (R-TX) controversial “Consumer Freedom Option” which would have allowed insurers to sell bare bones, non-ACA compliant plans, and a proposal from Sen. Rob Portman (R-OH) that would have added $100 billion to help Medicaid expansion enrollees purchase private insurance.
  • July 26: In a 45-55 vote, the Senate rejected a GOP plan to repeal the ACA without an immediate replacement. The measure was similar to a 2015 GOP reconciliation bill that passed Congress but was vetoed by President Obama. The Congressional Budget Office (CBO) projected that legislation would have resulted in 32 fewer Americans with coverage and premiums to double over 10 years.
  • July 27: Senate Republicans released a slimmed-down ACA repeal bill referred to as a “skinny repeal.” The bill would eliminate the individual mandate, repeal the employer mandate for eight years, defund Planned Parenthood for one year, eliminate the ACA’s Prevention and Public Health Fund, temporarily repeal the medical device tax, amend the ACA’s 1332 waivers to allow states greater flexibility to roll back insurance regulations, and increase contribution limits to health savings accounts for three years. The skinny repeal bill failed to pass after Republican Senators Susan Collins (ME), Lisa Murkowski (AK), and John McCain (AZ) joined all 46 Democrats and two Independents in opposing the bill. The CBO projected the skinny repeal would have resulted in 16 million more uninsured Americans and a 20 percent increase in premiums over 10 years.

With Senate Republicans failing to pass various iterations of ACA repeal and replace—all of which were unpopular with the general public and were projected to result in large increases in the uninsured and the cost of coverage—it remains to be seen if Congress  can now work in a bipartisan fashion to stabilize the individual market. There are also questions as to how the Trump administration will proceed in carrying out the ACA, given the President’s and HHS Secretary Tom Price’s public attacks on the law.