After seven years of vowing to repeal the Affordable Care Act, Senate Republicans Wednesday fell short in their effort to undo major portions of former President Barack Obama's health law.
The vote was 55-45, with seven Republicans joining all 46 Democrats and the Senate's two independents in rejecting a measure by GOP Sen. Rand Paul of Kentucky. It would have repealed most of former Obamacare, with a two-year delay but no replacement. Congress passed nearly identical legislation in 2015 and sent it to Obama, who vetoed it.
Yet this time, with a president in the White House who says he's eager to sign repeal legislation, the measure failed on the Senate floor. The Congressional Budget Office has estimated that repealing the Affordable Care Act without replacing it would cost more than 30 million Americans their insurance coverage, and that was a key factor in driving away more Republican senators than Majority Leader Mitch McConnell could afford to lose in the closely divided Senate.
The result frustrated other GOP senators, some of whom expressed disbelief that their colleagues would flip-flop on legislation they had voted for only two years ago and long promised to voters. Of the current Republican senators, only moderate Susan Collins of Maine opposed the 2015 repeal bill.
"Make no mistake: Today's vote is a major disappointment to people who were promised full repeal," said Sen. Ben Sasse of Nebraska. "We still have a long, long way to go — both in health policy and in honesty."
Yet the outcome was hardly a shock in a Senate that's already shown that unity is elusive when it comes to dealing with Obamacare. The real-world implications of repeal have proven sobering to GOP senators answering to voters who've come to rely on expanded insurance coverage under the law.
What the party's senators will end up agreeing on instead is far from clear. Yet they plunged forward with debate toward their unknown goal, pressured by an impatient president. By week's end, Republicans hope to reach agreement among themselves, and eventually with the House, on some kind of repeal and replacement for the Obama law they have reviled for so long.
"We have to keep working hard," said McConnell, R-Ky. "We're determined to do everything we can to succeed. We know our constituents are counting on us."
One possibility taking shape in talks among senators is a "skinny repeal" that would abolish just a few of the key elements of Obama's law, including its mandates that everyone purchase insurance and its taxes that all GOP senators oppose. But in a sign of the general confusion, some said the tactic was aimed chiefly at moving the process forward into the purview of a committee of Senate-House bargainers, while others expressed the hope that the House would swallow a "skinny bill" whole, freeing Congress to move on to other issues.
Either way, after weeks spent on the issue including false starts and near-death experiences that have eaten up months of Trump's presidency, the realization was dawning on senators that they may be unable to pass anything more complex for now than a lowest-common-denominator bill.
"At the end of the day, we've got to start somewhere. This is a start," said Sen. Thom Tillis, R-N.C.
The day's proceedings began with prodding from Trump, who's frequently changed his message throughout the health care debate and yet can claim some credit for resuscitating Senate talks after McConnell essentially declared them dead last week.
The president singled out Alaska Sen. Lisa Murkowski, who'd voted the day before against opening debate on the legislation, and also opposed a wide-ranging McConnell amendment Tuesday that offered a replacement for Obamacare and went down to defeat.
"Senator @lisamurkowski of the Great State of Alaska really let the Republicans, and our country, down yesterday. Too bad!" Trump wrote.
"I don't really follow Twitter that much," Murkowski remarked to reporters later with a shrug.
Murkowski was also among the seven GOP senators who voted "no" Wednesday on the repeal-only bill. The others were Collins, Shelley Moore Capito of West Virginia, Dean Heller of Nevada, John McCain of Arizona, Rob Portman of Ohio and Lamar Alexander of Tennessee.
In a statement defending his vote, Portman wrote: "We need a rescue plan for Ohio families who are suffering under the status quo, not one that makes the health care system worse for Ohio families."
Senators were working their way through 20 hours of debate. At week's end, a "vote-a-rama" of rapid-fire voting on a mountain of amendments is expected before moving to final passage — of something.
Internal GOP differences remain over how broadly to repeal the law, how to reimburse states that would suffer from the bill's Medicaid cuts and whether to let insurers sell cut-rate, bare-bones coverage that falls short of the Affordable Care Act's requirements.
While pressure and deal-making helped win over vacillating Republicans to begin debate, they remained fragmented over what to do next. Several pointedly left open the possibility of opposing the final bill if it doesn't suit their states.
"It seems the Republican majority is no clearer on what the end game is, because there's no good way out of this," said Minority Leader Chuck Schumer of New York.