Republicans’ latest attempt to repeal Obamacare just failed

As talks of a “skinny repeal” echo through the Capitol, conservatives’ hopes of a more heavyset repeal of Obamacare collapsed on Wednesday.

The Senate voted 55 to 45 against an amendment backed by conservatives that would repeal large swathes of Obamacare without a replacement. The repeal-only legislation provides a two year delay to give Congress time to find an alternative, and contrasts with the so-called “skinny” repeal which would leave most parts of Obamacare in place and may be voted on later this week. The catch is that if Congress to come up with a replacement in two years, 18 million people lose health insurance due to a large scaling back of Medicaid and the end of private insurance subsidies.

Still, conservatives argued that the dramatic consequences of the legislation were a virtue, not a vice. “The only way we’re going to be forced into a bipartisan compromise if we repeal it,” said Sen. Rand Paul of Kentucky in an impassioned speech on the Senate floor in support of the repeal-only legislation.

Many of his Republican colleagues disagreed, including normally reliable Republicans like Sen. Lamar Alexander of Tennessee and Sen. Rob Portman of Ohio. “I don’t think Tennesseans would be comfortable canceling insurance for 22 million Americans, and trusting Congress to find a replacement in two years,” Alexander said in a surprisingly critical statement. “Pilots like to know where they’re going to land when they take off and we should too.”

The legislation is one of several healthcare measures that the Senate is voting on this week following Tuesday’s narrow 51 to 50 vote to open up debate on the Trumpcare bill that the House of Representatives passed in May. Senators have no plans to pass the House bill as is but rather are proposing amendments that would almost completely replace that bill.

Senate Majority Leader Mitch McConnell’s options to do that, however, continue to dwindle with each day as he attempts to pass something, anything this week. On Tuesday night by a vote of 57 to 43, the Senate strongly rejected McConnell’s “Better Care Reconciliation Act” that his staff had carefully crafted behind closed doors over the past few months. There are several other proposals being floated, including the so-called skinny repeal, but McConnell is running out of both time and options to get something through his fractured caucus.

It’s this inability among Republicans to achieve consensus on an Obamacare replacement that conservatives like Paul began arguing for a clean repeal of Obamacare after 7 years of campaign promises. They point out that almost every Republican voted for very similar repeal legislation in 2015 (Obama vetoed it) and say it’s hypocritical not to vote for it again in 2017.

But many Republicans have pumped the brakes now that there is a Republican president willing to sign the legislation, believing that repeal without a replacement is reckless. “I cannot vote to proceed to repeal the ACA without reform,” Sen. Lisa Murkowski of Alaska said in a statement last week when the repeal-only legislation was being considered. She was joined last week by Sen. Susan Collins of Maine and Sen. Shelley Moore Capito of West Virginia but Paul insisted an actual vote be taken anyway, perhaps hoping that pressure from the Republican base would sway some lawmakers.

Instead, four additional Republicans came out against the legislation.

Murkowski, Capito, Collins, Portman, and other Republicans have voiced particular concern for removing Obamacare’s expensive Medicaid expansion which has provided healthcare coverage to more than 10 million people and would be completely rolled back by the repeal-only legislation.

Conservatives have said these concerns betray the small-government principles that define the Republican party. “It is about freedom of choice, it is not about actuarial tables,” Paul said on Tuesday. Such tables from the Congressional Budget Office have show that tens of millions of people would lose health insurance under the current proposals.

Senators have also been concerned because without a replacement, the amendment leaves in place most of Obamacare’s insurance regulations which could cause further confusion in the insurance market. Those regulations can only be repealed with 60 votes (Republicans currently have 52).

It’s these same parliamentary rules that delayed Wednesday’s vote by several hours as Republicans attempted to rewrite parts of the bill that took federal money away from Planned Parenthood.

McConnell is running out of runway but there is still a chance to pass something by the end of the week.