Obamacare has endured more than seven years of political attacks, dozens of congressional repeal votes and four Supreme Court challenges. But as of today, the Democrats’ universal health care law is as secure as it's ever been.

Sen. John McCain’s (R-Ariz.) opposition to the latest repeal effort sponsored by his closest friend in the Senate likely doomed the bill — and with it, the hope that Republicans could fulfill their campaign pledge to undo Barack Obama’s signature domestic policy achievement before a Sept. 30 deadline.


On top of that, the insurance markets are alive and, despite skyrocketing premiums and dwindling competition, face no threat of immediate collapse.

While the GOP repeal effort may not be over, it took a severe hit with McCain’s opposition just days before a Sept. 30 deadline. The 52-member Republican conference can afford to lose no more than two members. McCain joined Sen. Rand Paul (R-Ky.) as public “no” votes. In addition, Sen. Susan Collins of Maine is widely viewed as a "no" — she trashed the bill to her local paper on Friday — and Sen. Lisa Murkowski of Alaska is skeptical; both opposed the Senate repeal effort in July.

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“That’s certainly not a good development for passage of the bill,” Sen. John Thune (R-S.D.) said on Fox News shortly after McCain’s announcement. “But there are a couple of uncommitted members, and there’s an opportunity between now and Sept. 30, the end of next week, to get a vote on this.”

But the clock may have finally caught up with them. After Oct. 1, they would need 60 votes — an impossibility given Democrats’ support for the law.

Despite full control of the White House and both chambers of Congress, Republicans may have exhausted their options to legislatively undo the Affordable Care Act after nearly 10 months of work. Republicans will have one more chance to pass a bill with 51 votes in 2018, but GOP leaders have already earmarked that for tax reform.

"I'll be honest, it seems unlikely that we'll be voting on this” next week, Sen. Joni Ernst (R-Iowa) told a town hall meeting Friday in Iowa City shortly after McCain’s announcement, according to The Washington Post.

To be sure, Republicans could undermine the health care law in other ways — from pulling money for advertising, as Health and Human Services Secretary Tom Price has already done, to narrowing the enrollment window when people can sign up. Just today, HHS informed Obamacare outreach workers that HealthCare.gov will be shut down for maintenance for 12 hours nearly every Sunday during open enrollment.

To date, though, those efforts have weakened but not killed Obamacare’s markets, which have roughly 10 million enrollees this year. If the IRS should stop enforcing the law’s mandate requiring most Americans to have health coverage, however, that could change the equation.

The markets are likely to survive even a direct hit if President Donald Trump follows through on threats to cut off $7 billion in funding for key Obamacare subsidies. That’s because after months of uncertainty, insurers have built that possibility into their double-digit rate increases for next year. That means that even if the president finally pulls the payments to make a political point, or force Democrats to the table, the plans would likely be able to weather the financial blow.

“The carriers have largely baked in enough cushion for this foolishness,” said Robert Laszewski, an insurance consultant.

Insurers rely on the payments to reduce costs for their poorest Obamacare customers.

In addition, most Obamacare customers are unlikely to drop coverage anytime soon as more than 8 in 10 qualify for subsidies that largely shield them from the big price hikes in the pipeline for 2018. That means they’re insulated from even dramatic premium increases, putting a floor on how far enrollment can drop.

Now, Republicans will have to contend with how to talk about the law they’ve railed against for seven years but haven’t been able to repeal.

McCain called for the resumption of bipartisan talks over stabilizing the markets, led by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). Those negotiations collapsed this week after the Senate’s repeal effort gained steam and House Speaker Paul Ryan made clear the House wouldn’t enact a bill that made insurance company payments.

But even if they could reach an agreement — they were still relatively far apart on a narrow bill — there’s little chance that it could have a significant effect for the 2018 open-enrollment season, which begins on Nov. 1.

Insurers in most states need to make final decisions about participation and pricing in the coming week. Alexander had been aiming for a deal by Sept. 27.

“There’s really zero time on the clock,” Laszewski said. “There’s going to be a Republican civil war on this.”