Senate Republicans failed to pass their 'skinny bill' that would repeal parts of the Affordable Care Act on July 28. Three republicans, including Sen. John McCain (R-Ariz.), voted against the bill. (Amber Ferguson/The Washington Post)

The late-night dramatic defeat of their attempt at repealing Obamacare early Friday morning could be Republicans' last attempt to “repeal and replace.”

Republicans have been trying pretty much nonstop for the past six months, and it's clear they don't have an answer to their central dilemma: How to take government out of people's health care without causing millions more people to lose health care.

If an answer existed, health-care experts say a bill probably would have emerged by now that could pass with 50 out of 52 Republicans.

Conservatives were willing to go along with a last-minute proposal to just repeal the individual mandate of the Affordable Care Act, but two moderates, Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska), and Sen. John McCain (Ariz.) joined with all 48 Democrats to sink it. Health-policy experts say just getting rid of Obamacare's requirement that all people buy health care would make health insurance more expensive for everyone.


A protester holds a sign during a demonstration against repeal of the Affordable Care Act at the Capitol on June 21. (Astrid Riecken/Getty Images)

“They will have to at some point just say: 'Okay, we tried. And we're moving on,'" said Alice Rivlin with the Brookings Institution.

This could be that moment, because of public opinion and congressional deadlines.

A Washington Post-ABC News poll found half of Americans prefer Obamacare, compared to just 24 percent preferring Republicans' plan. A Kaiser Health poll finds 71 percent of Americans want Republicans to stop trying to repeal Obamacare and work with Democrats to make it better.

Republicans were also rushing to pass the health-care bill now because they're running up against a legislative deadline. For Senate Republicans to avoid a Democratic filibuster on any legislation, they have to vote on the legislation while they're debating the budget. (I've got an explainer on the reconciliation process here.)

By this summer, Republicans had hoped to wrap up the health-care debate, because that's when they need to start planning for next year's budget, which is a whole other potential drama involving debt ceilings and potential shutdowns. They had hoped to use that budget process to pass tax reform — again under a budget rule that lets them duck Democrats' wrath.

“Until health care is off the budget tracks,” said Sarah Binder, a procedural expert at the Brookings Institution, “a tax reconciliation bill is stuck in the rail yard.”

Republicans have a few options now to salvage their failure:

1) Do what President Trump is suggesting and just let Obamacare implode.

Sounds crazy, but it could be done, as The Fix's Aaron Blake explains here.

Except that strategy doesn't make much political sense. Republicans are in control of Washington and have very publicly tried to fix the nation's health-care system. They own whatever happens to it. If the health insurance markets collapse under Republicans' watch, it's likely voters will blame Republicans for it.

And as GOP strategist Alex Conant said to The Fix last week: “Voters have short memories for the unpleasantness around the sausage making, but ultimately, Republicans and the president will be judged by what happens with the health-care system next year.”

2) Work with Democrats to tweak Obamacare, not repeal it.

This isn't sexy. It's nowhere near what Republicans have been campaigning on — and winning on — for the past seven years. In fact, you could argue working with Democrats keep Obamacare law is the opposite of that. But this option at least gives Republicans another chance to uphold the meaning of their promise to repeal and replace Obamacare: to give people better health care. As Senate Majority Leader Mitch McConnell (R-Ky.) has said repeatedly: “Doing nothing is not an option.”

This idea is also becoming more popular among voters.


Republicans have tried to do something, anything, their own way. Since that failed, they're going to have to wave the white flag on their campaign promise to repeal and replace Obamacare, at least this Congress.

Their least-bad options now are to do nothing, or do something with Democrats.