Trumpcare Would Have Thrown 23 Million People Off Health Insurance. It Failed Because One Man Said No — John McCain's Thumbs-Down Vote.

The process that produced the AHCA was remarkable for its opacity. Republicans had campaigned on ACA repeal for seven years — through 60+ House votes to repeal the law during the Obama years — but had not produced a detailed replacement plan. When they finally had the presidency and both chambers of Congress, they rushed through a bill with minimal committee hearings, no bipartisan consultation, no CBO score before the House vote, and frantic last-minute changes to secure the 51 votes needed. The House passed it 217-213 on May 4, 2017. Members celebrated with a Rose Garden party. The CBO released its score two weeks later: 23 million more uninsured by 2026.

The Senate could not pass any version. The Better Care Reconciliation Act, the Obamacare Repeal Reconciliation Act, the Health Care Freedom Act — each failed. In a late July 2017 vote on the "skinny repeal" — a stripped-down bill that would have eliminated the individual mandate and a few other provisions — Senate Republicans needed 50 votes, with VP Pence as the tiebreaker. At approximately 1:30 AM on July 28, Senator John McCain — who had flown to Washington just days after being diagnosed with brain cancer — walked onto the Senate floor, paused, and extended his right thumb downward. The bill failed 49-51. The ACA survived. Trump and his allies never forgave McCain for it, and Trump refused to allow the flag to fly at half-staff when McCain died in August 2018 until public and congressional pressure forced him to.