Sen. Susan Collins, R-Maine (Photo: Collins)

Votes held today show the Republicans may still have a chance to push an Affordable Care Act (ACA) change bill through the Senate.

Seven Republican senators, including some who usually stick with other Republicans on major votes, crossed party lines today to vote against Senate Amendment 271, the so-called “skinny” ACA change bill.

Even more Republicans — nine — crossed party lines Tuesday to reject Senate Amendment 270, the “fat” ACA change bill.

(Related: Senate Prepares to Vote on Skinny ACA Change Proposal)

But Republican senators stuck together today to block two motions introduced by the Democrats.

Both of the Democrats’ motions could have sent the bill at the heart of the debate, H.R. 1628, back to the Senate Finance Committee for changes. One would require the committee to restore funding taken away from Medicaid, and one would change the bill to add protection for people with disabilities. The motions would, in effect, suspend debate on efforts to change the ACA. All Republicans voted against the Medicaid-related “motion to commit.” All 51 Republicans who voted on the disability-related motion voted against that motion.

A list of proposed, approved and rejected amendments is available here.

Budget Reconciliation

Republicans hold just 52 seats in the Senate. They need just 51 votes to pass budget bills and amendments through the Senate, and 60 votes to pass ordinary bills and amendments.

Republican opponents of the ACA need to meet complicated Senate budget measure consideration requirements to use the budget reconciliation process. They also have to contend with a conflict between Republican senators who want to maximize the help available to low-income people and people with health problems, and the views of Republican senators who care more about minimizing government involvement in paying for health care.

S.A. 267

Senate Majority Leader Mitch McConnell has tried to give all Republican senators a framework they can use to create an ACA change bill by introducing S.A. 267.

S.A. 267 would replace all of the current text of H.R. 1628, the ACA change bill the House passed by a 217-213 vote on May 4, with ACA change provisions that most Senate Republicans appear to support.

S.A. 267 would eliminate the current ACA mandates, taxes, penalties and exchange plan subsidy programs. It would not provide any replacements for the subsidy programs eliminated.

The ‘Fat’ Amendment

S.A. 270, the amendment that failed by a 43-57 vote Tuesday, is a long, ‘fat’ ACA change bill that would replace the current ACA income-based premium tax credit subsidy with a new, age-based subsidy.

The amendment would also create new individual major medical insurance market stabilization state grant programs; create a multi-state association health plan program for small businesses; and encourage states to give residents access to de-regulated, unsubsidized individual major medical coverage outside the ACA public exchange system.

The ‘Skinny’ Amendment

S.A. 270, the short, ‘skinny’ amendment that failed by a 45-57 vote today, would eliminate the same mandates, taxes and penalties S. 267 would eliminate. That amendment would also eliminate ACA Medicaid expansion funding, the ACA public exchange system and the ACA premium tax credit subsidy program.

The list of Republicans who voted against that amendment includes Lamar Alexander of Tennessee; Shelley Moore Capito of West Virginia; Susan Collins of Maine; Dean Heller of Nevada; John McCain of Arizona; Lisa Murkowski of Alaska; and Rob Portman of Ohio.

— Read Trump Calls on GOP to ‘Repeal Obamacare’ Amid Uncertainty on Votes on ThinkAdvisor