Members of the Senate voted 51 to 48 early Thursday to approve Senate Concurrent Resolution 3, a framework for attacking the Affordable Care Act.
Republicans defeated all Democratic efforts to limit the scope of the attack on the health law, but some Republican senators repeatedly crossed party lines to vote for the attack limit proposals. All Democrats who were present voted the same way every time.
Sen. Dianne Feinstein, D-Calif., did not vote, because she was at home recovering from pacemaker surgery.
Republicans hold only 52 seats in the Senate. ACA critics need 51 votes in the Senate to pass a budget measure limiting ACA program funding, and 60 votes to pass any legislation that changes or replaces the law.
The Republicans' narrow margin in the Senate means that the Republican senators who frequently crossed party lines today — Susan Collins of Maine and Dean Heller — may have a strong influence over whatever ACA de-funding, ACA change or ACA replacement legislation gets through Congress in the next few months.
Senate Concurrent Resolution 3 would attack the ACA by directing congressional committees to come up with spending cuts and revenue increases related to federal health care programs.
The rules governing Senate budget measures are complicated. Some Republicans are hoping that ACA critics can use a budget resolution to get full ACA repeal through the Senate with just 51 votes, but many observers say ACA critics can use a budget measure only to defund major ACA programs, such as the ACA premium tax credit program.
Collins is part of a group of five Republican senators who proposed an unsuccessful effort to give the congressional committees until March 3 to come up with a proposal for replacing the ACA. The deadline in the version of the resolution that actually passed is Jan. 27.
President Trump said during a press conference Wednesday that he would like to see Congress repeal the ACA and replace the law at about the same. To do that, ACA critics would need to hold on to most or all Republicans in the Senate. The ACA critics would have to win over eight Democrats and independents, and at least one additional Democrat or independent for every Republican who defects.
When the Senate was voting on the proposed limits to the scope of Senate Concurrent Resolution 3, the aisle-crossers hinted at the types of issues that could bring Republicans and Democrats together.
Collins and Heller voted to keep Social Security, Medicare and Medicaid out of the budget resolution ACA attack process; to exclude any provisions that might undermine gains in children's health; and to shut out any provisions that would "make people with disabilities and chronic conditions sick again," by allowing a return to medical underwriting or caps on annual or lifetime caps on benefits.
Collins, Heller and two additional Republican senators, Shelley Moore Capito of West Virginia and Rob Portman of Ohio, voted against letting the budget resolution hurt rural hospitals and health care providers.
Collins also voted to keep insurers from considering people's occupations when deciding whether to issue coverage and setting people's premiums.
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