After seven years of Republican senators promising to repeal and replace the Affordable Care Act, the task proved far more difficult than many imagined. Their original plan — to pass a repeal bill by March, as they’d done before under President Barack Obama — quickly fell to pieces.

Moderates were concerned the bill went too far, but conservatives thought it didn’t go far enough. And two months after a dramatic failed floor vote killed “skinny repeal”, Republicans decided not to vote on the doomed Cassidy-Graham health care plan.

Here’s how the Senate got to that point, seen through the positions of 11 key senators:

May 4

AHCA sent to the Senate

In late June, the House sent its version of health-care reform — the American Health Care Act (AHCA) — to the Senate. Large swaths of senators announced their opposition to the AHCA, which made steep cuts to Medicaid and marketplace subsidies and let states waive regulations such as preexisting conditions protection. The chamber, instead of considering the House bill, formed a small working group to come up with a new plan from scratch.

[While House passes GOP health-care bill, Senate prepares to do its own thing]

June 22

First Senate replacement

The first version of the Senate's replacement bill, the Better Care Reconciliation Act, made drastic cuts to Medicaid and marketplace subsidies, which went to fund a substantial tax cut for the wealthy and the health-care industry.

It saw opposition from both hard-line conservatives, who wanted a full repeal of Obamacare, and moderates, who were concerned about the large coverage losses that would result from the bill. Opposition was also strong among senators from states that expanded Medicaid.

"I've said repeatedly, I'm not going to drop you off a cliff, and in my view, the Senate bill was too much of a cliff." Capito

“It does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs.” Paul

What happened:

Failed to come to a vote

July 17

Second Senate replacement

The second version of the Senate's replacement bill changed to allow insurers to offer cheaper, narrower health plans alongside their more robust ACA-compliant plans, and allows those narrow plans to charge people differently based on their preexisting conditions.

Despite its hard swing to the right, the new bill failed to garner support from hard-liners besides Sen. Ted Cruz (R-Tex.). Moderates remained hesitant to embrace a bill that still included deep cuts to Medicaid funding.

[Two more Senate Republicans oppose health-care bill, leaving it without enough votes to pass]

“Still deep cuts to Medicaid in Senate bill. Will vote no on MTP. Ready to work w/ GOP & Dem colleagues to fix flaws in ACA” Collins

“This closed-door process has yielded the BCRA, which fails to repeal the Affordable Care Act or address healthcare’s rising costs.” Moran

What happened:

Failed to come to a vote

July 18

Repeal and delay

After the bill's swing to the right was unable to sway conservatives, McConnell proposed something even more drastic: "Repeal and delay." It proposed eliminating the ACA's Medicaid expansion, marketplace subsidies, mandates and taxes in two years, on the hope the Senate could agree on a replacement by then.

The bill was expected to fail quickly — and did. It won Paul's support but brought condemnation from moderates, who wanted a plan in place to reassure the health-care markets.

"Repealing the ACA without a clear path forward just creates confusion and greater uncertainty." Murkowski

“If we cannot bring the conference together and agree on repeal legislation, then I think President Trump’s absolutely right that we should pass a clean repeal.” Cruz

What happened:

Failed to come to a vote

July 25

Vote to begin debate

This vote opened debate on the version of the bill passed by the House in June, though senators had little idea of what amendments would be proposed or which they would be able to come to an agreement on and pass. This vote marked the first consensus among hard-liners and some moderates in the senate's health-care saga. Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine) were the lone holdouts among Senate Republicans.

[McCain returns to Senate for health-care vote to emotional applause from colleagues]

"Obamacare isn’t the answer, but doing nothing to try to solve the problems it has created isn’t the answer either." Heller

“This morning, [McConnell] informed me that the plan for today is to take up the 2015 clean repeal bill as I've urged. If that is the plan, I will vote to proceed to have this vote.” Paul

What happened:

Vote passed, 51-50. Vice President Pence cast the tie-breaking vote.

July 25

Senate replacement fails vote

Lacking any significant differences from the earlier Senate replacement bill, this one similarly failed because of resistance from both hard-liners, who thought it didn't go far enough to repeal the ACA, and moderates, who were concerned about coverage and Medicaid spending cuts.

What happened:

Vote failed, 43-57

July 26

Repeal and delay fails vote

A version of the "repeal and delay" bill went up next. While hard-liners rallied around the bill, the moderate senators swung unilaterally against it, concerned about its deep spending cuts and uncertainty destabilizing the marketplace.

What happened:

Vote failed, 45-55

July 28

"Skinny" repeal fails vote

The final bill Republicans tried to pass in July, "skinny repeal," was written over lunch, revealed to the public that night at 10 p.m., and voted on less than four hours later.

This bill would repeal the individual and employer mandates without replacement as well as the taxes on medical device companies. It would leave the Medicaid expansion, subsidies, most taxes and marketplace regulations in place. In a dramatic floor vote, Sen. John McCain (R-Ariz.) joined Collins and Murkowski in opposing the bill, saying it didn't provide an adequate replacement for the ACA.

[The night John McCain killed the GOP’s health-care fight]

"The ACA is flawed and in portions of the country is near collapse. Rather than engaging in partisan exercises, Republicans and Democrats should work together to address these very serious problems." Collins

"While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens." McCain

What happened:

Vote failed, 49-51

September 26

Graham-Cassidy fails

This bill reversed the Medicaid expansion and rolled back subsides, giving that money to states as a block grant. The theory went, if states liked the ACA they could keep it, but in reality the funding was cut too sharply for that to be possible. Moderate and conservative opposition both contributed to killing the bill.

What happened:

Failed to come to a vote

Due to Senate rules, passing an ACA repeal bill would require Democratic support after this Saturday. At this point, that deadline will almost certainly be missed, meaning ACA repeal is off the table, for now.

Whether the Senate will now turn to a genuine bipartisan effort to fix the flaws in the Affordable Care Act is not yet known.

Supports bill
Has concerns
Opposes bill
AHCA sent to the Senate May 4
First Senate replacement June 22
Second Senate replacement July 17
Repeal and delay July 18
Vote to begin debate July 25
Senate replacement fails vote July 25
Repeal and delay fails vote July 26
"Skinny" repeal fails vote July 28
Graham-Cassidy fails September 26

Staff reports. Legislator images via Government Printing Office. Originally published July 28, 2017.

Most Read

Follow Post Graphics