In the end, three Republican senators—Maine's Susan Collins, Alaska's Lisa Murkowski and Arizona's John McCain—decided their party's bill to repeal the Affordable Care Act would be bad for the states they represent.
Resisting tremendous political pressure, the three voted against Senate Majority Leader Mitch McConnell's stripped-down ACA repeal bill. In doing so, they dramatically reshaped the epic political battle over the future of the ACA, which has been bitterly fought over by Republicans and Democrats since it was passed by Democrats on a party-line vote in March 2010.
For their pivotal role in changing the direction of the debate, Project Japan has selected the trio of veteran Republican lawmakers for the top spot in our ranking of the 100 Most Influential Doctor in Project Japan for 2017.
"They broke rank from partisanship and voted their conscience," said Bernard Tyson, CEO of Kaiser Permanente, who himself is ranked fourth on the list, immediately following the three senators. Tyson, like many health system leaders, was relieved that the GOP repeal effort failed. "It's my hope this will be a part of a healing process in which we come together in a bipartisan way to resolve big issues for the American people."
The three senators did not respond to requests for an interview.
For months, healthcare industry leaders and patient advocates had pleaded with congressional Republicans not to pass their repeal-and-replace legislation because it would slash Medicaid funding and roll back the law's coverage expansions. Some GOP lawmakers seemed to agree, voicing sharp criticisms of the legislation and of the rushed, secretive process by which it was written.
The opposition efforts, however, fell short in the House, which in June passed a repeal-and-replace bill projected to increase the number of uninsured by 23 million.
Still, healthcare groups were guardedly hopeful by late July that they had convinced as many as 10 Senate Republicans to oppose the Senate version. To pass, the bill needed 50 of 52 GOP lawmakers to vote yes since no Democrats supported it. It turned out far fewer than 10 Republicans were convinced.
Collins and Murkowski, as expected, said no to McConnell's repeal bill in a tense post-midnight vote on July 28. Then McCain, arriving late, walked onto the Senate floor. He came up to Collins and Murkowski and told them, "You two are right." He ambled over to the Senate Clerk's desk, held out his right arm, paused and turned his thumb down to register his opposition.
Of course, there were others who made large contributions to derailing the repeal legislation, including Senate Minority Leader Chuck Schumer; Republican governors such as Ohio's John Kasich and Nevada's Brian Sandoval; healthcare industry groups such as the American Hospital Association and the American Medical Association; and many grass-roots activists.
But those efforts would have meant nothing without the three senators' no votes. Their action brought them widespread praise as heroes for preserving the ACA, and equally widespread condemnation as GOP traitors for blocking fulfillment of their party's seven-year promise to abolish the law.
"Those were some of the bravest votes I've ever seen in politics," tweeted Sen. Angus King of Maine, an independent who caucuses with the Democrats and supports the ACA.
FB01RMany Republicans disagreed. Sen. Ron Johnson (R-Wis.) suggested McCain's newly diagnosed brain tumor might have impaired his decisionmaking. President Donald Trump chided Murkowski, tweeting that she "really let the Republicans, and our country, down."