The Republican effort to dismantle the Affordable Care Act collapsed early Friday when a slimmed-down Senate measure to pare back selected pieces of the 2010 health-care law failed, undermining the GOP leaders' last-ditch effort to deliver on a longtime campaign promise.
In a 49-51 vote, the Senate rejected a measure to roll back a handful of elements of the law. The bill's failure exposed the difficulty Senate Republicans faced in trying to corral 50 votes for any legislation making changes to the ACA, whether modest or major.
The bill's failure leaves Republicans without any clear next step in their monthslong effort to roll back the ACA and with no significant legislative accomplishment during President Donald Trump's first seven months in office.
After weeks of internal debate over how to dismantle and replace the health-care law, often called Obamacare, Senate Republicans had settled on a stripped-down plan to pare back pieces of it, after a series of broader proposals failed earlier this week to secure the 50 votes needed to pass.
But support even for the bare-bones measure foundered Thursday, when Senate Republicans became nervous that the House would take the bill up and pass it, rather than using it to start fresh negotiations between the two chambers.
House Speaker Paul Ryan (R., Wis.) responded late Thursday with a cautious statement saying the House would be willing to negotiate, and he spoke later over the phone to a handful of concerned senators.
"If moving forward requires a conference committee, that is something the House is willing to do," Mr. Ryan said in a statement signaling frustration with the Senate Republicans' difficulty in coalescing around a health bill.
Senate Majority Leader Mitch McConnell (R., Ky.) had argued that the measure would have enabled negotiations to continue, but it wasn't clear that those could have produced a viable compromise.
"Passing this legislation will allow us to work with our colleagues in the House toward a final bill that can go to the president, repeal Obamacare and undo its damage," Mr. McConnell said as he unveiled the bill's text only hours before the vote.
The "skinny" repeal would have undone the ACA's requirement that most people purchase health insurance or pay a penalty, and it would have suspended enforcement through 2025 of a related requirement that most employers offer coverage. An unpopular tax on medical devices would have been delayed through 2020, and funding would also be rescinded for a $1 billion public-health program run through the Centers for Disease Control and Prevention.
The bill also attempted to expand the use of ACA state waivers to get rid of some insurance regulations, such as a requirement that health plans cover mental-health services and maternity care, though lawmakers are limited by budget rules in how much flexibility they can write into the legislation. Republicans blame the ACA's regulations for inflating the cost of insurance premiums, while Democrat say they provide needed protections to consumers.
A Congressional Budget Office estimate released late Thursday said the bill could result in 16 million more people losing insurance in a decade and premiums rising roughly 20%.
Democrats criticized the GOP legislative process that led to a bill unveiled only hours before the unsuccessful vote.
"This is nuclear-grade bonkers what is happening here tonight," said Sen. Chris Murphy (D., Conn.). "When you get rid of the mandate, every single insurance company will tell you that rates skyrocket because you're not getting rid of the provision that requires insurance companies to price sick people the same as healthy people."
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