The Senate Gallery was packed for 1:00 a.m. on a bleak Thursday night, or more accurately Friday morning. It was a relief just to sit down, after we had been rallying outside the Capitol for six hours. Of course, these six hours were piled on top of night after night, week after week, of standing with disability rights groups, reproductive rights organizations, people fighting for transgender equality, and thousands of other individuals fighting to keep the Affordable Care Act (ACA) and the current structure of Medicaid in place.[1] No one believed the 2010 law was perfect, but the ACA was the first successful effort to regulate the health insurance market and ensure that low- and middle-income families as well as people with pre-existing conditions could access affordable and comprehensive care.[2] So we had fought, seemingly nonstop, for months to prevent these consumer protections from being repealed, as the Republican Party had been promising to do for the seven years since Obamacare was signed into law. It had been a long summer.

“The goal is to be having this exact same conversation in four weeks, in four months, and in four years.” Coalition leaders and representatives repeated variations on this statement throughout my summer internship at the National Health Law Program. This message seemed to be at odds with those familiar with the saying, “the definition of insanity is doing the same thing over and over again but expecting different results.” However, in a country whose politics are defined by a two-party system with contradictory viewpoints, every election can mark a complete reversal of ideology and progress. Thus it became the goal of many advocates to do everything in their power to delay Congress and the new administration from passing any legislation that would irreversibly harm the health care system in America.

Speculations were rampant. We needed three Republicans to vote against the bill to repeal the ACA—that had been released only three hours earlier—to prevent them from getting the simple majority of votes they would need to overhaul our entire healthcare system.[3] Local and national advocates had been targeting specific states and specific Senators for months, emphasizing the many ways the efforts to repeal and replace the ACA would harm their constituents. We were feeling pretty good about Senators Murkowski and Collins, but no one knew for sure. On top of that, we still had no idea who would have the courage to part from party lines and cast that last negative vote.

Shortly after sitting down in the mezzanine to watch the Senate floor from above, the voting began. The parliamentarian called out the Senators names, asking for their vote. I was surprised at how few of the Republican Senators verbalized their votes at this time. The Democratic Senators voiced resounding calls of “nay” when their name was announced, but many of the Republicans stayed quiet. I knew this was not a show of agreement, since the legislators have the luxury of voting when they wish to do so, and the roll call is merely a formality. As we waited for the “yay” votes to build up to the simple majority line, I noticed that some of the Senators would merely walk up to the front of the room and just show their support for the bill by giving a “thumbs up” sign. These Senators had me reeling in my seat. A thumb’s up? That is how adults vote? That is how the leaders of our country choose to indicate how they feel about robbing millions of people of health insurance? It was excruciating.

All eyes were on Senator McCain. There was considerable debate in the advocacy community about what his next move would be after his recent return to Washington, D.C. with a diagnosed brain tumor,.[4] I watched in horror as Vice President Pence walked across the room, with Senator McCain closely following, to go through a back door where they could speak in private. We learned later that the President had been on the phone, strongly encouraging Senator McCain to vote in favor of the repeal.[5] At the time, however, this backroom conversation looked like the end. In what felt like hours later—but in reality was probably only minutes—Senator McCain emerged from the door, no longer accompanied by the Vice President. He slowly walked up to the front of the room where so many of his party members had given their thumbs up to repeal the ACA. He stretched out his hand, fingers spread. We watched with bated breath. Then, against all odds, he closed his fist and turned his thumb down.[6] It seemed unreal. Everyone in the gallery was looking around anxiously to try to make sense of what was happening. Then sure enough, the Parliamentarian read through the list of Senators, and the “nay” votes—including Senators Murkowski, Collins, and McCain—counted up to 51.

This dramatic vote was not the end, however. While Senator McConnell’s efforts to repeal the ACA had failed, other Senators were quick to jump into the ring with their own bills to decimate the consumer protections and critical features of Obamacare. The most recent attempt is the Graham-Cassidy bill,[7] and once again we are trying to find three Republican Senators who will recognize the devastation that such a repeal would create for people with limited resources. Senators McCain and Rand Paul have thus far indicated their opposition to the legislation, and Senator Collins seems to have her hesitations as well.[8] However, the authors of the bill and the administration are still working to retain their party votes, and they have until September 30, 2017 to make this repeal happen in accordance with the Senate budget reconciliation procedures.[9] The disability rights, health care advocates, reproductive justice, and trans equality organizations have been instrumental in pushing the vote back for so long. If you are wondering what you can do now to save Medicaid,[10] people with pre-existing conditions, essential health benefits, and further marketplace instability, now is a great time to leave a voicemail for Senator Collins. In fact, you can call the Washington, D.C. office at (202) 224-2523,[11] press 1, simply say you oppose the Graham-Cassidy bill, and your voice can make a difference for millions of people.

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[1] See, e.g., Robyn Powell, Disability Activists Have Been Fighting for Us All Along, Dame Mag. (Aug. 2, 2017), https://www.damemagazine.com/2017/08/02/disability-activists-have-been-fighting-all-us-all-along; Miriam Berg, Proof that Speaking Out to Say #IStandWithPP Makes a Difference, Planned Parenthood Action Fund (Mar. 24, 2017), https://www.plannedparenthoodaction.org/blog/proof-that-speaking-out-to-say-istandwithpp-makes-a-difference; Diana Feliz Oliva, Repealing Obamacare Puts Trans Lives in Danger, Vice Impact (June 8, 2017, 12:54 PM), https://impact.vice.com/en_us/article/wjqxg5/repealing-obamacare-puts-trans-lives-in-danger.

[2] See Compare Proposals to Replace the Affordable Care Act, Kaiser Family Found. (updated Sept. 13, 2017), http://www.kff.org/interactive/proposals-to-replace-the-affordable-care-act/.

[3] See Robert Pear & Thomas Kaplan, Senate Rejects Slimmed Down Obamacare Repeal as McCain Votes No, N.Y. Times (July 27, 2017), https://www.nytimes.com/2017/07/27/us/politics/obamacare-partial-repeal-senate-republicans-revolt.html.

[4] Jessie Hellman, McCain votes to advance ObamaCare repeal, replace after vowing to oppose, Hill (July 25, 2017, 11:16 PM), http://thehill.com/policy/healthcare/343828-mccain-votes-to-advance-gop-obamacare-repeal-replace-bill-after-vowing-to.

[5] Alana Romain, What Did Trump Say to John McCain on the Phone? They Spoke Before the Health Care Vote, Romper (July 31, 2017), https://www.romper.com/p/what-did-trump-say-to-john-mccain-on-the-phone-they-spoke-before-the-health-care-vote-73189.

[6] Dan Merica, McCain’s Thumbs Down Caps Contentious Relationship with Trump, CNN (July 29, 2017, 10:07 AM), http://www.cnn.com/2017/07/29/politics/mccain-contentious-relationship-with-trump/index.html.

[7] Kim Soffen, There’s One Obamacare Repeal Bill Left Standing. Here’s What’s in It, Wash. Post (Sept. 6, 2017), https://www.washingtonpost.com/graphics/2017/politics/cassidy-graham-explainer/?utm_term=.1d38fc12287a.

[8] Lauren Fox, Collins: ‘Very Difficult for me to Envision a Scenario’ Where she Backs GOP Health Care Bill, CNN (updated Sept. 24, 2017, 10:13 AM), http://www.cnn.com/2017/09/24/politics/susan-collins-graham-cassidy-decision/index.html.

[9] Sheryl Gay Stolberg & Robert Pear, Why the Latest Health Care Bill is Teetering: It Might Not Work, N.Y. Times (Sept. 23, 2017) https://www.nytimes.com/2017/09/23/us/obamacare-repeal-graham-cassidy-mccain-trump.html.

[10] 5 Ways the Graham-Cassidy Proposal Puts Medicaid Coverage at Risk, Kaiser Family Found. (Sept. 19, 2017), http://www.kff.org/medicaid/fact-sheet/5-ways-the-graham-cassidy-proposal-puts-medicaid-coverage-at-risk/.

[11] Contact, Susan Collins: U.S. Senator for Me., https://www.collins.senate.gov/contact (last visited Sept. 24, 2017).