ACA Repeal Failures and Sabotage: Losing 51-49, Then Dismantling Piece by Piece
The administration's attempt to repeal and replace the ACA failed through three separate legislative vehicles: the American Health Care Act (AHCA) passed the House but died in the Senate; the Better Care Reconciliation Act failed to advance in the Senate; and the 'skinny repeal' (Health Care Freedom Act) failed 51-49 when McCain, Murkowski, and Collins voted against it. Following legislative failure, the administration cut the Navigator program (enrollment assistance) from $63 million to $10 million, reduced the open enrollment window, and created an association of short-term health plans that could deny coverage for pre-existing conditions. Termination of cost-sharing reduction payments to insurers triggered premium increases and a complex subsidy dynamic that ultimately cost the government more than the payments themselves.