The Senate on Wednesday rejected a bill that would have repealed major pieces of Barack Obama’s health reforms without a replacement, something Republicans have promised to do for seven years.

Seven Republican senators joined with Democrats to reject the bill, in a sign that the party’s promise to repeal the Affordable Care Act “root and branch” will be extremely difficult.

In a 45 to 55 vote, senators Shelly Moore Capito of West Virginia, Susan Collins of Maine, Dean Heller of Nevada, Rob Portman of Ohio, Lamar Alexander of Tennessee, Lisa Murkowski of Alaska, and John McCain of Arizona opposed the measure.

All but Collins had previously voted for the same legislation in 2015 to repeal major parts of Obamacare without replacement.

This plan is favored by small-government conservatives, such as Rand Paul, a libertarian from Kentucky, who have been clamoring to repeal the law for years. The CBO estimated that 32 million people would lose health insurance over the next decade under this plan compared to current law.

John Thune of South Dakota said he understood why a number of Republican colleagues flipped on clean repeal of the Affordable Care Act. “I think there are a number of our members who voted for repeal in 2015 who believe now we should be doing repeal and replace simultaneously,” he said.

The senior Senate Republican added: “It’s a different environment out there than it was then, and I think now a lot of people who voted against it are of the mind that we can’t repeal and just say we’re going to do something in the next 24 months. We need a replacement alternative now.”

In contrast, maverick conservative Ben Sasse of Nebraska railed against those of his colleagues who voted against the bill.

“With just one exception, every member of the Republican majority already either voted for repeal or explicitly campaigned on repeal,” said the first-term Republican. Sasse continued: “Today’s vote is a major disappointment to people who were promised full repeal. We still have a long, long way to go both in health policy and in honesty.”

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The vote marks the latest twist in the zig-zag struggle of Senate Republicans to rally votes on healthcare reform.

On Tuesday, Republican senators, riven by disagreement over how to proceed on healthcare, voted to move towards debate on healthcare, but hours later their seven-year repeal effort suffered a setback when a replacement plan fell far short of the requisite 60 votes needed overcome a procedural hurdle. After months of deliberation, almost entirely behind closed doors, only 43 of 52 Republican senators supported the leadership’s most comprehensive plan to replace the healthcare law.



Though failure was expected – as approval in this case would have required 60 votes and therefore Democratic support – the vote was a discouraging signal to a Republican leadership who are still trying to wrangle the party to get behind a healthcare measure that can pass by the end of the week.

But a new plan emerged as the leading contender to replace the 2010 healthcare law. A day after the Senate narrowly voted to open debate on repealing the Affordable Care Act (ACA) despite not knowing where it would lead, the so-called “skinny repeal” seemed the most probable of a number of options for the repeal or replacement of the ACA to succeed

The “skinny repeal” would eliminate the individual mandate, the least popular provision of the ACA that requires all Americans to have health insurance or face a fine. It would also remove the employer mandate, requiring certain businesses to provide health insurance to employees, as well as a tax on medical device manufacturers. But, importantly, it would not touch the Medicaid program for the poor.



This plan, which continued to gain traction with Senate Republicans on Wednesday, would not achieve Republicans’ long-stated goals to remove the healthcare law’s insurance regulations and lower premiums for healthcare costs. It would, however, provide a tactical option for moving a bill forward while buying Republicans more time to work out a broader plan later.

“The so-called skinny provision is not a resolution of this problem,” said senator Lamar Alexander, a Republican from Tennessee and the chairman of the Senate health, education, labor and pensions committee. “It only takes us to the next step where hopefully we can find one.”

If that measure passed the the Senate with a simple majority, it would likely then enter a conference committee with the House, where Republicans could reconcile the differences and produce a larger repeal-and-replace measure later.

Democrats are largely unable to stop a bill from moving forward. Locked out of power in Congress and the White House, the party has remained united in opposition to any measure that would repeal the law, but has enjoined Republicans to work with them on solutions that would stabilize the insurance markets and lower premiums.

But as Republicans continued to work their way through a planned 20 hours of debate and prepared to vote for a series of amendments in a so-called “vote-a-rama”, it was unclear whether anything would be passed by the deadline of the end of this week set by the Senate majority leader, Mitch McConnell.

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“Now we have to keep working hard,” McConnell said on Wednesday. “We’re determined to do everything we can to succeed. We know our constituents are counting on us.”

At a rally in Youngstown, Ohio, on Tuesday night, Donald Trump warned that Republican senators who did not support legislation to repeal and replace Obamacare “will have a lot of problems”.



On Wednesday morning, the president singled out Lisa Murkowski of Alaska, one of two Republican senators who opposed opening debate on healthcare legislation. Murkowski was joined by Susan Collins of Maine.

“Senator @lisamurkowski of the great state of Alaska really let the Republicans, and our country, down yesterday,” Trump tweeted. “Too bad!”

Republican senators have still failed to reach a consensus on a repeal plan to dismantle the 2010 healthcare law, which would affect coverage for millions of Americans and impact a sixth of the US economy.

Democrats, though, have urged activists to continue putting pressure on lawmakers as the Senate entered the final, frenetic push toward repeal. For months, voters and activists have inundated the telephone lines of Republican lawmakers and protested at their offices.

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At a Planned Parenthood protest on the Capitol lawn Wednesday evening, Democratic lawmakers laid out the stakes.

“Keep doing you. Keep being you,” Senator Kamala Harris, a Democrat from California, told the crowd. “Keep doing what you’ve been doing because it’s working and it matters and it counts.”

“Thirty-six hours,” she added, referring to the amount of time left before the repeal vote. “So let’s keep calling. Let’s keep tweeting. Let’s keep writing. Let’s keep marching. Let’s keep shouting and we will win!”



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