Dive Brief:

• The Senate bill to replace the Affordable Care Act (ACA) is dead now that four Republicans senators have said they will not support continued debate on the measure.
• This doesn't mean the ACA is safe however. Republican Senate Leader Mitch McConnell said he will now work on repealing the act even if there is no replacement plan. This has also been the urging of President Donald Trump, but other members of the GOP are wary of the uncertainty such a move would create.
• While the healthcare industry's concerns with The Better Care and Reconciliation Act (BCRA) revolved around rolling back coverage rates and the massive cuts to Medicaid, the death blow came from hard-right Republicans who didn't think the bill went far enough in repealing the ACA.

Dive Insight:

The GOP won’t easily give up its best chance to repeal the ACA since the law was enacted, but its options are dwindling. McConnell said in a statement the Senate will now vote to repeal the ACA with a two-year delay before it takes effect, but admitted the effort to immediately replace the act has failed.

Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!

— Donald J. Trump (@realDonaldTrump) July 18, 2017

This means one of the most disruptive aspects of the BCRA — a foundational change to Medicaid that included more than $800 billion in cuts and the end to expansion of the program — has been tabled. With a clean repeal of the ACA now a priority — and multiple other Republican legislative plans in the wings — it seems unlikely to be pushed again anytime soon.

But supporters of repealing the ACA without a replacement will undoubtedly still face outrage from the healthcare industry and patient advocates. A report from the Congressional Budget Office found repeal without replacement would decimate coverage rates and also raise premiums in the non-group market.

The BCRA carried provisions that employers would have found favorable, according to sources who spoke with HR Dive. The elimination of penalties associated with the employer mandate and the increase in caps on employer contributions to health savings accounts (HSAs) appealed to several employer advocates.

The BCRA was already on thin ice and plans to hold a vote in the Senate kept getting delayed. Along with the general public, major hospital and doctors’ groups were strongly opposed to the bill that was estimated by the CBO to leave 15 million people without insurance as soon as next year.

But the biggest thorn in McConnell’s side were the members of the especially conservative Freedom Caucus, who wanted no vestiges of the ACA to remain. On Monday night, Sen. Mike Lee and Utah and Sen. Jerry Moran of Kansas went public with their firm opposition to BCRA. Sen. Rand Paul of Kentucky had already made a similar statement. Sen. Susan Collins of Maine was also a “no,” but unlike the others, she wanted a more moderate bill.