Late last week, the US Senate tried unsuccessfully to pass a full repeal and replace bill, a partial repeal bill, and a “skinny” repeal of the Affordable Care Act (ACA). In a series of high profile votes, Senate Majority Leader Mitch McConnell (R-KY) skipped the committee process of the Senate and held floor votes in an attempt to force through a bill that can be reconciled with the US House. Unfortunately for Republicans, Senator McConnell was unable get the necessary votes to move the bill forward at this time.

What seemed like defeat two weeks ago, forced Senator McConnell to act. Two weeks ago, several Senators came out against the Better Care Reconciliation Act (BCRA), the Senate version of repeal and replace for the ACA. Senator McConnell had to act on voting on the repeal or fail to even attempt a key Republican campaign promise. Thus, Senator McConnell brought the bill to the floor, even when he was not positive he would have the necessary votes to pass any repeal or replace bill.

On July 25, the Senate held the procedural vote to allow debate on health care bills. This procedural move was not an actual vote on the merits of the bill, only to allow the debate to begin. This barely passed, with 50 Senators voting aye, and Vice President Pence casting the tiebreaking vote.

After several hours of debate on July 25, the Senate brought up the BCRA for a full vote of the Senate with an amendment from Senator Ted Cruz (R-TX) and $100 billion in additional Medicaid funding. BRCA had all 48 Democrats voting against the bill and nine Republicans voting against. The vote effectively killed the repeal and replace measure. This bill required a full 60 Senate votes to pass.

On July 26, Senator McConnell brought to the floor a partial repeal bill. This bill would have repealed the ACA in two years to give the Senate time to formulate a replacement. The bill would only require a simple majority, instead of the 60 votes necessary for a repeal and replace. The bill failed. 55 to 45, with seven Republican voting against passage.

Finally, in the early morning hours of July 28, Senator McConnell brought the “skinny” repeal amendment. The “skinny repeal” would have removed the individual mandate, removed the employer mandate for eight years, given the states more flexibility in what benefits states could mandate, eliminate the medical device tax for three years, among other changes. The CBO scored the bill with 15 million individuals losing health insurance next year.

In a dramatic vote, Senator John McCain (R-AZ), along with Senator Murkowski (R-AK) and Senator Collins (R-Me) and the Senate Democrats voted against the “skinny repeal.” The bill was defeated 51 to 49.

The defeat of the “skinny repeal” was one of the last attempts that Senator McConnell could make to pass some form or repeal of the ACA. There have been tweets by President Trump urging Republican Senators to continue to push for a vote and secure a repeal. However, Senate Republicans have indicated they may be moving on to other policy priorities.