Senate Majority Leader Mitch McConnell (Photo: Senate)

Three Senate Republicans early Friday helped Senate Democrats block efforts to use the budget reconciliation process to get an Affordable Care Act (ACA) change bill through the Senate.

All Democrats and independents in the Senate voted against Senate Amendment 667, an 8-page “skinny” change bill released by Senate Republican leaders today.

Most Republicans voted for the proposed amendment, but three crossed party lines to vote against it: John McCain of Arizona, Susan Collins of Maine, and Lisa Murkowski of Alaska. 

(Related: ‘Final’ Senate GOP ACA Change Bill Draft Is 8 Pages Long)

The amendment, which would create the Health Care Freedom Act bill, would repeal the ACA individual mandate and the ACA individual mandate, extend the current ACA medical device tax suspension, increase health savings account contribution limits, and provide $2 billion for state health insurance risk programs and other market stabilization efforts.

The bill would leave ACA taxes, the ACA exchange system, ACA benefits mandates and the ACA Medicaid expansion program in place.

Earlier in the evening, McCain and three other Senate Republicans said they could vote for the bill only if they could receive ironclad assurances that House and Senate leaders would form a conventional conference committee to come up with a better version of the bill.

Those four senators, who apparently already had seen a copy of the bill, argued that it was a bad bill that would not actually repeal the Affordable Care Act.

Senate Majority Leader Mitch McConnell said the Senate will move on tomorrow to consider a major defense bill.

Senate Democratic Leader Chuck Schumer rose to say after the vote that Democrats recognize that the ACA has flaws and would like to see the Senate try to develop a bipartisan change bill through “regular order.”

Republicans hold a majority of the seats in the House and 52 of the 100 votes in the Senate. Under traditional Senate rules, Republicans need 60 votes to get an ordinary bill through the Senate and 51 votes to get a budget bill through the Senate. That means that, in theory, they could get a health bill through Congress with no Democratic votes in either the House or the Senate.

To get an ordinary ACA change bill through the Senate under regular order, would-be ACA changers would have to persuade at least eight of the 48 Democrats and independents in the Senate to support the bill.

Schumer said Democrats are interested in some of the ACA change ideas proposed by Sen. Bill Cassidy, a medical doctor from Louisiana.

Schumer named Orrin Hatch of Republican and Lamar Alexander of Tennessee as examples of Republicans who have worked with Democrats to come up with successful bipartisan bills in the past.

— Read 4 ACA Change Paths That Just Got More Popular on ThinkAdvisor.