How key senators changed their positions to bring down Obamacare repeal

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]

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.

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]

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.

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]

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.

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.

"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]

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.