Senate Republicans Fail by a Razors Edge.

In the early morning hours, the Senate took up a vote to repeal parts of The Affordable Care Act. This “skinny” repeal eliminates the penalties that uphold the individual mandate and would seek to dismantle the Prevention and Public Health Fund. Senate Republicans had already put themselves on a narrow path to successfully pass any repeal efforts following the series of failed efforts the weeks before. On Friday night, Senate Majority Leader Mitch McConnell unveiled a barebones bill (in comparison to it’s more ambition predecessors) to a vote in hopes of getting it passed by using obscure Senate rules. The goal being to bring a bill to the floor that could pass, regardless of its substance, and create a broader proposal that could keep the repeal process alive. The vote outcome was expected to be predictable and thought to tout party lines with a handful of exceptions. All Senate Democrats would oppose the bill while a handful of Republicans, most notably Maine’s Susan Collins and Alaska’s Lisa Murkowski were expected to oppose. That would then leave 50 Republicans as ‘yes’ votes, making Vice President Vice Pence the tiebreaker.

There was a curveball however. Arizona senator John McCain, making a dramatic return to the Senate following a recent brain cancer diagnosis, cast his vote against the repeal bill. Audible gasps were heard in the Senate chamber, as McCain made a symbolic thumbs down gesture and audibly said ‘no’ as he cast his vote. The repeal bill failed by a single vote. McCain’s vote was an upset to many who did not foresee him abandoning the party line, particularly after a (maybe not so surprising) yes vote on opening debate to the repeal process. McCain’s vote was decisive in this single repeal vote. However, there are many substantial and overlooked reasons as to why repeal efforts have failed thus far.

The Republicans have been ultimately fighting an uphill battle from the beginning of the Congressional calendar. While having a majority in both houses, the Affordable Care Act is now more popular than it is unpopular. Certain elements of the ACA, particularly those that make coverage mandatory even if you have a preexisting condition and expand access to medicaid, are popular across party lines. Public approval has a dramatic influence on the decision making of legislators and has shown to be a factor in the debate, even for conservative lawmakers. Lobbying on behalf of governors has been critical, as state executives have called for a bipartisan solution to protect state’s medicaid expansion.

Full out repeal of the ACA is also deeply unpopular with private interests. Many of which have benefitted from the medicaid expansion and the various subsidies to insurers and hospitals. Many of these entities have lobbying heavily against recent repeal efforts and are calling for an overhaul to the current system. Major shareholders in the healthcare debate such as the American Association of Retired Persons (AARP), the American Medical Association, along with hundreds others have stated their opposition to repeal without a replacement. This is not surprising considering the magnitude of a measure that would impact nearly ⅕ of the total U.S economy. This does not even consider the human cost of such a bill, and the severe, long term implications of repealing such a massive piece of healthcare legislation.

All of these factors show why it is increasingly difficult for Republicans to pass a repeal effort. It is also increasingly difficult to see any tactical advantage for Congressional Republicans to pursue such efforts. As pressure mounts and the right loses its window to pass any major overhaul, one should wonder what the rationale is for conservatives to push such an unpopular agenda. Yet the right is seemingly split on the implications of repeal. Many claim, including those in the Trump wing of the party, that the right would lose face if they didn’t follow through on their promise to repeal. However, there have been a variety of outspoken critics who see the implications of attaching the party to such an unpopular measure.

They are correct in doing so. If Mitch McConnell and President Trump continue to push for repeal, the party and the conservative movement will be indefensibly tied to a failed effort to take medical coverage away from millions of Americans. While there has been bipartisan consensus on the shortcomings of the ACA, particularly those in regards to insurance markets, these problems will not be addressed by full repeal. The failure to acknowledge these complexities is in part the reason for their inability to execute their repeal. So while Senators Colins, McCain, and Murkowski may not have voted against this legislation to appease supporters of the Affordable Care Act, they may in fact have saved the face of their own divided party.