In another full day of discussion about repealing and replacing the Affordable Care Act, there are still no clear options on the table on which the Senate can vote.

Democrats are united in opposition to any bill that would undo President Obama's legacy on health care. Republican leaders are pinning their hopes on a last ditch effort that senators are calling "skinny repeal."

Senate Majority Leader Mitch McConnell and others continued to work on it all day. The goal is to offer legislation that does the minimum in terms of undoing Obamacare, as the Affordable Care Act is commonly known. That would allow Republican lawmakers to return to their home states during the August recess and say they've taken action on an issue that's been one of their key campaign promises for years.

The bill's language is not yet final or public, but as NPR's Sue Davis reports on All Things Considered, it is said to involve some combination of repealing the individual mandate, some of the taxes in the ACA, defunding Planned Parenthood for at least a period of time and allowing states to opt out of some of the minimum standards of coverage for insurance plans that the Affordable Care Act requires.

In an impromptu press conference held Thursday evening, Sen. Lindsey Graham, R-S.C., along with three other Republican senators, stressed they would vote for the "skinny repeal" bill only with more assurances that the bill, if passed, would actually not become law. They want it to proceed to a conference committee, where House and Senate members would work on crafting another bill that combines each chamber's version — instead of having the Senate bill sent directly to the House floor for a vote.

"I'd rather get out of the way and let it collapse than have a half-ass approach where it is now our problem," Graham said.

Sen. John McCain, R-Ariz., who joined his friend Graham at the press conference, said the Republican effort to replace Obamacare deserves more time and consideration than it was being given.

"I believe one of the major problems with Obamacare is that it was rammed through Congress by Democrats without a single Republican vote," McCain said. "I believe we shouldn't make that same mistake again."

McCain added, "It's time we sat down together and came up with a piece of legislation that addresses this issue."

However, it is unlikely that if the bill makes it to conference with the House that it will involve Democratic input, if its stated goal continues to be repealing the Affordable Care Act.

Graham and McCain were joined at the press conference by Sen. Ron Johnson, R-Wisc., and Sen. Bill Cassidy, R-La.

The strategy of supporting the "skinny repeal" is not one a lot of Republicans want to get behind. If it does become law and a "death spiral" could begin--which means that without a mandate to buy insurance, younger people who tend to be healthier will drop their insurance, keeping sicker people in the market and then premiums go up. The bill may leave in place subsidies, however.

But all day lawmakers were either unclear what would be in the bill, or suggesting that they would pass whatever it might be, simply to extend the process. From passage, the bill could go straight to the House floor for a vote, or move into a conference committee.</s>In another full day of discussion about repealing and replacing the Affordable Care Act, there are still no clear options on the table on which the Senate can vote.

Democrats are united in opposition to any bill that would undo President Obama's legacy on health care. Republican leaders are pinning their hopes on a last ditch effort that senators are calling "skinny repeal."

Senate Majority Leader Mitch McConnell and others continued to work on it all day. The goal is to offer legislation that does the minimum in terms of undoing Obamacare, as the Affordable Care Act is commonly known. That would allow Republican lawmakers to return to their home states during the August recess and say they've taken action on an issue that's been one of their key campaign promises for years.

The bill's language is not yet final or public, but as NPR's Sue Davis reports on All Things Considered, it is said to involve some combination of repealing the individual mandate, some of the taxes in the ACA, defunding Planned Parenthood for at least a period of time and allowing states to opt out of some of the minimum standards of coverage for insurance plans that the Affordable Care Act requires.

In an impromptu press conference held Thursday evening, Sen. Lindsey Graham, R-S.C., along with three other Republican senators, stressed they would vote for the "skinny repeal" bill only with more assurances that the bill, if passed, would actually not become law. They want it to proceed to a conference committee, where House and Senate members would work on crafting another bill that combines each chamber's version — instead of having the Senate bill sent directly to the House floor for a vote.

"I'd rather get out of the way and let it collapse than have a half-ass approach where it is now our problem," Graham said.

Sen. John McCain, R-Ariz., who joined his friend Graham at the press conference, said the Republican effort to replace Obamacare deserves more time and consideration than it was being given.

"I believe one of the major problems with Obamacare is that it was rammed through Congress by Democrats without a single Republican vote," McCain said. "I believe we shouldn't make that same mistake again."

McCain added, "It's time we sat down together and came up with a piece of legislation that addresses this issue."

However, it is unlikely that if the bill makes it to conference with the House that it will involve Democratic input, if its stated goal continues to be repealing the Affordable Care Act.

Graham and McCain were joined at the press conference by Sen. Ron Johnson, R-Wisc., and Sen. Bill Cassidy, R-La.

The strategy of supporting the "skinny repeal" is not one a lot of Republicans want to get behind. If it does become law and a "death spiral" could begin--which means that without a mandate to buy insurance, younger people who tend to be healthier will drop their insurance, keeping sicker people in the market and then premiums go up. The bill may leave in place subsidies, however.

But all day lawmakers were either unclear what would be in the bill, or suggesting that they would pass whatever it might be, simply to extend the process. From passage, the bill could go straight to the House floor for a vote, or move into a conference committee.</s>The Steps Ahead For The Senate On Health Care

The Senate has voted to debate their measures on health care overhaul. Steve Inskeep talks with reporter Noam Levey of the Los Angeles Times about the latest.

President Trump took an opportunity yesterday to repeat a simple promise.

PRESIDENT DONALD TRUMP: We're going to give you great health care.

INSKEEP: The promise has been straightforward to make. The problem is keeping it. The president himself said shortly after taking office, nobody knew, nobody knew health care could seems so complicated. Now the United States Senate is confronting that reality. Lawmakers voted yesterday to begin debate on repealing and replacing the Affordable Care Act with something or with nothing, no clear idea what the plan is. Senator John McCain's vote was crucial. He returned from surgery and a cancer diagnosis to cast that vote in favor of starting debate. And then, as other senators listened, he said they're not doing it right.

JOHN MCCAIN: Why don't we try the old way of legislating in the Senate, the way our rules and customs encourage us to act? If this process ends in failure, which seems likely, then let's return to regular order.

INSKEEP: Senators then suffered an initial failure. A replacement plan was blocked last night. Noam Levey is national health care reporter for the LA Times. And he's on the line. Good morning.

INSKEEP: So the basics first, what actually did the senators commit to with the vote to begin debate?

LEVEY: So what they're technically doing is bringing up the repeal and replace bill that passed the House of Representatives in May. But in practical terms, what this means is that the Senate has begun debating potential replacements for that replacement.

INSKEEP: Oh, because nobody believes that that measure from the House would pass the Senate in that form.

INSKEEP: And then they put this other proposal on the table last night. What proposal was it that they killed?

LEVEY: Well, Senator - Senate Majority Leader Mitch McConnell had come up with his preferred repeal and replace bill, which had been slightly modified over the last couple of weeks in the course of negotiations with conservative Republican senators, like Ted Cruz, more centrist Republican senators like Rob Portman, who are concerned about Medicaid. That was viewed as one possible option for Republicans. But that - it didn't even come close.

INSKEEP: And now we have another vote coming up, most likely today, on just straight repeal - just repeal the Affordable Care Act. What's the effect on the public if that were to pass?

LEVEY: Well, the Congressional Budget Office, the nonpartisan scorekeeper for Congress, has calculated that would lead to 32 million fewer Americans with health insurance over the next decade, pretty dramatic.

INSKEEP: Which maybe explains why people don't expect that to pass either.

LEVEY: That's - that approach has always been the favorite of the most conservative wing of the Republican Party. But it has very little support with the public, certainly not with Democrats. And even many centrist Republican senators have said they won't back that either.

INSKEEP: So Senator McCain pointed out, this is a strange way to do a bill, actually. It's not the way they would normally have done it in the past. What have you thought about, as a reporter, as you've watched this story unfold?

LEVEY: Well, I've been covering Washington for almost a dozen years, which is short by the...

INSKEEP: By McCain's standards, but OK.

LEVEY: I've never seen anything like this. The normal committee process, which Senator McCain alluded to in his remarks, would send a piece of legislation, especially one as complex as this one, through a series of committee hearings in which experts would weigh in, the law - the legislative language would be submitted for analysis by the Congressional Budget Office and others so that lawmakers would have an idea of not only what was in the legislation but what the potential impact could be.

One of the remarkable things about the process we're in right now is that not only are the two plans that you and I discussed unlikely to go forward; we don't know what will go forward. That means that lawmakers, over the next day or two, will likely be asked to vote on something, anything that repeals part or all or none of the Affordable Care Act without a clear idea of how many people may be impacted by that, how many people would gain or lose health insurance, how - what would happen to insurance protections that people currently rely on. All that is a question mark.

INSKEEP: You know, when John McCain talked about regular order, some people have pointed out he was talking about this process, this technical process, but also talking about a frame of mind - wasn't he? - the idea that senators would deliberate, that they would think about things, that they would listen to one another, that if you do things under the normal rules, you'd also get input from the minority party. They might actually amend it in some way that makes it feel less bad to them, right?

LEVEY: I think that is the hope. And that's a sentiment that's been expressed, I think, with increasing urgency in Washington over the last six months. And that, in part, reflects, I think, the president. But I think it also reflects this headlong rush that Republicans have been in to repeal the Affordable Care Act. And that's been, obviously, an extremely partisan an issue for seven years. But I think there is a hope, at least on the public side, that this process would have been more constructive.

INSKEEP: Wouldn't - isn't this something that Republicans - very, very briefly - Republicans decried this way of approaching things?

LEVEY: They certainly did. It was a talking point they went to time and again for the last seven years.

INSKEEP: OK, Noam Levey of the Los Angeles Times, thanks very much.</s>Jonathan Weisman, deputy Washington editor for The Times, explains the voting and amendment process that the bill to repeal and replace the Affordable Care Act must go through next.</s>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a “skinny repeal” that rolls back an unpopular portion of the federal health law. But experts warn that the idea has been tried before, and with little success.

Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act’s “individual mandate,” which assesses a tax on Americans who don’t have insurance, along with penalties for employers with 50 or more workers who fail to offer health coverage.

Details aren’t clear, but it appears that — at least initially — the rest of the 2010 health law would remain, including the rule that says insurers must cover people with preexisting medical problems.

“We need an outcome, and if a so-called skinny repeal is the first step, that’s a good first step.”

In remarks on the Senate floor Wednesday, Minority Leader Chuck Schumer (D-N.Y.) said that “we just heard from the nonpartisan Congressional Budget Office that under such a plan … 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.” A bipartisan group of 10 governors – including Ohio’s John Kasich and Nevada’s Brian Sandoval – signed a letter echoing these concerns and urging the Senate to reject it.

But earlier in the day, some Republicans saw this concept as a means to advance the debate.

“We need an outcome, and if a so-called skinny repeal is the first step, that’s a good first step,” said Sen. Thom Tillis (R-N.C.).

Based on published reports, several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach. It is, at least for now, being viewed as a step along the way to Republican health reform.

“I think that most people would understand that what you’re really voting on is trying to keep the conversation alive,” said Sen. Bob Corker, R-Tenn. “It’s not the policy itself … it’s about trying to create a bigger discussion about repeal between the House and Senate.”

But what if, during these strange legislative times, the skinny repeal were passed by the Senate and then became law? States’ experiences with insurance market reforms and rollbacks highlight the possible trouble spots.

By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash from the coverage requirement rules they previously put on the individual market. When some of the rules were repealed, “things went badly.”

Considering the parallels

 By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash from the coverage requirement rules they previously put on the individual market. When some of the rules were repealed, “things went badly,” said Mark Hall, director of the health law and policy program at Wake Forest University.

Premiums rose and insurers fled, leaving consumers who buy their own coverage, because they don’t get it through their jobs, with fewer choices and higher prices.

That’s because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with preexisting conditions. At the same time, they didn’t include mandates that consumers carry coverage.

That goes to a basic concept about any kind insurance: People who don’t file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, leaving them with only the more costly policyholders.

Bottomline: Insurers end up “less willing to participate in the market,” said Hall.

It’s not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage, which could blunt the effect of not having a mandate.

Bottomline: Insurers end up “less willing to participate in the market.”

During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be “strong incentives for people to obtain health insurance and keep it year-round.”

About 6.5 million Americans reported owing penalties for not having coverage in 2015.

Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult poll said they want the Senate to keep eight, rejecting only the individual mandate.

Even though the mandate’s penalty is often criticized as not strong enough, removing it would still affect the individual market.

“Insurers would react conservatively and increase rates substantially to cover their risk,” said insurance industry consultant Robert Laszewski.

That’s what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state’s insurance commissioner. By 1998, the state’s largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, “precipitating a sense of crisis,” according to a study published in 2000 in the Journal of Health Politics, Policy and Law.

“When one pulled out, the others followed,” said current Washington Insurance Commissioner Mike Kreidler, who was then a regional director in the federal department of Health and Human Services.

The state’s individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, won the authority back.

Predicting the effect of removing the individual mandate is difficult, although he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.

“Few markets can go bad on you as fast as a health insurance market.”

“Few markets can go bad on you as fast as a health insurance market,” said Kreidler.

As for employers, dropping the requirement that those with 50 or more workers offer health insurance or face a financial penalty could mean some workers would lose coverage, but their jobs might be more secure, said Joe Antos, at the American Enterprise Institute.

That’s because the requirement meant that some smaller firms didn’t hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.

The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.

However, the individual market could be roiled by other factors, Antos said.

“The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges [— the state and federal markets through which insurance is offered —] work more poorly.”</s>The Senate is expected to begin a "vote-a-rama" Thursday on legislation to repeal and replace the Affordable Care Act.

The "vote-a-rama" — which occurs after the Senate debates for 20 hours on proposed legislation — allows any senator to introduce an unlimited number of amendments that are voted on without debate.

After the comprehensive replacement bill and the "clean" repeal bill were defeated this week, GOP leaders are now looking to pass a "skinny repeal" bill that would make limited changes to the Affordable Care Act, or Obamacare.

You can watch the proceedings live in the player above.</s>Though the Senate voted to advance the Republican-backed American Health Care Act of 2017, which would repeal and replace the Affordable Care Act, three key Republican Senators declared their opposition to the current “skinny repeal” of Obamacare on Thursday afternoon.

Lindsey Graham, R-S.C., John McCain, R-Ariz., and Ron Johnson, R-Wis., announced that they will not vote if a “skinny repeal” remains at the heart of the AHCA. They criticized the bill for not fulfilling promises they made to their constituents about a full repeal of President Obama’s health care bill:

“None of us believe it actually replaces Obamacare,” said Graham about the “skinny repeal,” eventually calling the legislation a “fraud.”

RELATED: A Georgia Republican says someone should “snatch a knot in their ass” when a senator broke on health care

Additionally, the senators spoke of the need for both parties to work together toward a better health care policy for all Americans. “I believe that one of the major problems with Obamacare was that it was rammed through Congress by Democrats without a single Republican vote,” said McCain, who recently gave a speech on bipartisanship before his colleagues. “I believe we shouldn’t make that same mistake again.”

The “skinny repeal” is what many have considered a watered-down version of the initially proposed full repeal. It has been criticized for not addressing key provisions of the ACA that many Republican politicians promised to replace.</s>What's Next In The Health Care Debate?

Senate Republicans have at least narrowed the options on what comes next for the Affordable Care Act — casting two separate votes since Tuesday that knocked out a "repeal-only" proposal and rejected a plan for replacement.

So, as lawmakers resume debate on Thursday, they will be staring at basically one possibility: a so-called "skinny repeal" that would surgically remove some key provisions from Obamacare, while leaving the rest intact — at least for now.

The skinny repeal would take out requirements for individuals and employers to get health insurance — a feature that is central to the Affordable Care Act's goal of expanding risk pools and lowering costs. The GOP plan would get rid of the medical device tax, intended as a revenue source to fund the current health law. The proposal would also eliminate a public health fund provision.

Senators have already rejected the Better Care Reconciliation Act replacement plan and a repeal-only proposal so far. The nonpartisan Congressional Budget Office has said the Better Care Reconciliation Act would have left 22 million more people uninsured by 2026, whereas simply repealing Obamacare without an immediate replacement would have resulted in 32 million more without health care insurance in the same time frame. The CBO estimated on Wednesday, at the request of Democrats, that a skinny repeal could result in 16 million more uninsured.

Nine GOP senators said no to the Better Care Reconciliation Act on Tuesday: Susan Collins of Maine, Tom Cotton of Arkansas, Bob Corker of Tennessee, Lindsey Graham of South Carolina, Dean Heller of Nevada, Mike Lee of Utah, Jerry Moran of Kansas, Lisa Murkowski of Alaska and Rand Paul of Kentucky.

Earlier attempts to get that bill to the floor were stalled by a lack of support.

Collins and Murkowski, who voted Tuesday against even proceeding to debate, also came out against the repeal-only proposal on Wednesday. They were joined by Republicans Heller, Shelley Moore Capito of West Virginia, John McCain of Arizona, Rob Portman of Ohio and Lamar Alexander of Tennessee.

"I'm for repeal and replace, and we're going to continue to work on replacement," Portman said after Wednesday's vote.

The ultimate outcome of both votes had been a foregone conclusion, says NPR's Susan Davis. "This was really an exercise about forcing senators to lay their cards down on the table," she tells All Things Considered. "We didn't know where a lot of these senators were as a hard yes or no."

As the debate moves forward, the Senate's skinny repeal could be completely rewritten through the amendment process — and that is likely to play out over the next week, says Davis.

Republicans and Democrats alike will be able to offer unlimited amendments, as long as they're germane to health care. "We expect hundreds of them will be offered to the bill. They will be whittled down from there," Davis says. It's a process known in the Senate as "vote-a-rama."

Once that happens, Senate Majority Leader Mitch McConnell will need to take stock again to see which GOP senators he needs to get in line in order to pass a fully amended skinny repeal.

"The working strategy for Republicans is to get a lowest-common denominator — something they can all agree on in order to get enough support to move it to a conference committee," where differences would have to be settled with the House, Davis says. Throughout the health care debate, Republican leadership has faced disagreement from both moderate and conservative members about how to proceed.

Democrats, meanwhile, are universally opposed to both measures and therefore sidelined in the debate. But one amendment proposed by Sen. Steve Daines, R-Mont., calls for a single-payer system — a move designed to get Democrats on the record. Some — such as Vermont independent Sen. Bernie Sanders, who typically caucuses with Democrats — would be happy to support the measure, whereas others facing tough re-election battles in 2018 might be less enthusiastic.</s>Senate Republicans are still trying to reach consensus on overhauling health care. Their focus now is on a so-called "skinny repeal" of the Affordable Care Act, which would eliminate a few key aspects of Obamacare.

Here & Now's Jeremy Hobson talks with Julie Rovner (@jrovner), chief Washington correspondent for Kaiser Health News, about the ongoing debate over how to repeal and replace parts of the ACA, and what a skinny repeal might look like.</s>WASHINGTON (Reuters) - The seven-year Republican quest to scrap Obamacare, a major campaign vow by President Donald Trump, lay in ruins on Friday after the Senate failed to dismantle the healthcare law, with congressional leaders now planning to move on to other matters.

John McCain, the maverick 80-year-old senator and 2008 Republican presidential nominee, cast the deciding vote in the dramatic early-morning showdown on the Senate floor as a bill to repeal key elements of Obamacare was defeated, 51-49, dealing Trump a crushing political setback.

McCain, who flew from Arizona this week after being diagnosed with brain cancer and was heading back for further treatment starting on Monday, joined fellow Republicans Susan Collins and Lisa Murkowski in voting with Senate Democrats unified against the legislation.

“It’s time to move on,” Senate Majority Leader Mitch McConnell, whose reputation as a master strategist was diminished, said on the Senate floor after the vote at roughly 1:30 a.m. (0530 GMT).

While House of Representatives Speaker Paul Ryan said fellow Republicans should not give up on healthcare, he cited other pressing issues that needed attention, including major tax-cut legislation sought by Trump.

“We have so much work still to do,” Ryan said in a statement.

The Senate’s healthcare failure called into question the Republican Party’s ability to govern even as it controls the White House, Senate and House of Representatives.

Trump has not had a major legislative victory after more than six months in office, and his administration is mired in investigations into contacts between his election campaign and Russia and high-level White House staff infighting. He had promised to get major healthcare legislation, tax cuts and a boost in infrastructure spending through Congress in short order.

Also on the legislative agenda are spending bills for the fiscal year beginning Oct. 1 to avoid a government shutdown and raising the U.S. debt limit.

Speaking in Brentwood, New York, on Long Island, Trump expressed dismay at the bill’s failure, saying, “I said from the beginning, let Obamacare implode and then do it (pass legislation). I turned out to be right. Let Obamacare implode.”

Trump, who earlier on Twitter said the three Republicans who voted no “let America down,” again took aim at lawmakers in his own party. “Boy, oh boy, they’ve been working on that one for seven years,” he said in Brentwood. “Can you believe that? The swamp. But we’ll get it done.”

Some lawmakers urged a bipartisan effort to buttress the existing healthcare system. With the partisan divide as wide as ever in Washington, it remained to be seen if a bipartisan approach can get off the ground.

McCain said the defeated bill did not offer meaningful reform and that its defeat presents “an opportunity to start fresh” on legislation crafted by lawmakers in both parties.

“I encourage my colleagues on both sides of the aisle to trust each other, stop the political gamesmanship and put the healthcare needs of the American people first,” McCain said.

Top congressional Democrats urged a bipartisan effort to fix problems in the Obamacare law without repealing it. “Change it, improve it, but don’t just take a knife and try to destroy it and put nothing in its place,” top Senate Democrat Chuck Schumer said.

Democratic Senator Bill Nelson said he was working with Republican Collins on a bipartisan effort on healthcare.

Senator John McCain (R-AZ) speaks with reporters after voting against the "skinny repeal" health care bill on Capitol Hill in Washington, U.S., July 28, 2017. REUTERS/Aaron P. Bernstein

While Ryan was able to secure House passage of a comprehensive bill to gut Obamacare in May, McConnell earlier in the week was unable to win passage of similarly broad healthcare legislation amid intraparty squabbling and competing demands by hard-line conservatives and moderates. On Friday morning, he failed to get even a stripped-down, so-called skinny bill over the finish line.

BACKLASH FEARED

Killing the Affordable Care Act, Democratic former President Barack Obama’s signature domestic policy achievement dubbed Obamacare, has been a passion for Republicans since its 2010 enactment over their unified opposition, and was a key campaign promise by Trump last year.

Republicans lawmakers, some of whom have been gleeful about razing Obama’s presidential legacy, now fear a backlash from their conservative political base that could affect the 2018 congressional elections.

For the moment, the Affordable Care Act, which extended health insurance to 20 million people and drove the percentage of uninsured people to historic lows, remains in place and must be overseen by an administration that is hostile to it.

This leaves health insurers unsure of how long the administration will continue to make billions of dollars in Obamacare payments that help cover out-of-pocket medical expenses for low-income Americans.

Schumer warned against any efforts to sabotage the law.

The Blue Cross Blue Shield Association, which represents insurers across the country, said it would work to ensure a smooth open enrollment period from Nov. 1-Dec. 15 and stabilize the individual insurance market under Obamacare for the long term.

Shares of health insurers, which had fought against the bill’s proposed repeal of the mandate that Americans obtain insurance, were up. Aetna Inc rose 0.9 percent, Anthem Inc gained 2.3 percent and Humana Inc edged up 0.2 percent.

Slideshow (16 Images)

On Wall Street, shares of hospitals were mostly higher because of the dwindling prospects for big cuts in the Medicaid insurance program for the poor and disabled. Community Health Systems Inc rose 2.2 percent, HCA Healthcare Inc gained 0.6 percent and Tenet Healthcare Corp edged up 0.1 percent. Republicans have long denounced Obamacare - which expanded Medicaid and created online marketplaces for individuals to obtain coverage - as an intrusion by government on people’s healthcare decisions.

Veteran House Republican Tom Cole said he thought there were “a number” of other Republican senators who were uncomfortable with the Senate’s healthcare legislation but were able to vote “yes” knowing McCain’s vote would kill it.

Republican Senator Lindsey Graham, a close friend of McCain, met on Friday with Trump to discuss Graham’s proposal to take tax money raised by Obamacare and send it back to the states in the form of healthcare block grants, the senator’s office said.

The skinny bill, released just three hours before voting began, would have retroactively repealed Obamacare’s penalty on individuals who do not obtain health insurance, repealed for eight years a penalty on certain businesses that do not provide employees with insurance and repealed a tax on medical devices until 2020.
The American Health Care Act of 2017, an attempt to repeal the Patient Protection and Affordable Care Act, fails passage in the United States Senate.