A multi-year Republican drive to repeal the Affordable Care Act (ACA) hit a significant roadblock in the early hours of July 28, 2017 when the Senate was unable to muster the votes to pass any form of ACA repeal or repeal/replace legislation – even a stripped down, so-called “skinny” version of HR 1628 offered by Senate Majority Leader Mitch McConnell.  McConnell’s plan, which essentially would have served as a placeholder to keep the legislative process moving, would have eliminated the penalties associated with the mandates that most individuals purchase insurance and certain employers offer insurance, extended the medical device tax moratorium, and made other very limited changes to the law. While House Speaker Paul Ryan expressed a willingness to give the Senate an opportunity to conference with the House on additional modifications to the bill, it was not enough to secure passage, and the McConnell amendment failed on a 49-51 vote.

The path ahead is uncertain at this point, given the deep policy divisions within the Republican Party regarding the nature of changes that should be made to the ACA (and given the unanimous Democratic opposition to the ACA repeal/reform bills advanced by Republican leaders to date). While revisions to the ACA – even bipartisan improvements considered through the committee process – could be considered in the future, right now there does not appear to be a clear way forward for ACA reform. The first test may be whether Republicans will accept Senate Minority Leader Charles Schumer’s request that a bipartisan effort be made to strengthen insurance markets.