‘Senate Republican leaders hoped to bring the measure to the Senate floor for a vote this coming week. But the bill is on life support after Senator John McCain, the unpredictable Arizona Republican whose dramatic “no” vote killed the previous repeal effort, announced on Friday that he could not “in good conscience” vote for the bill. He joined Senator Rand Paul, Republican of Kentucky, in opposition — and Senator Susan Collins, Republican of Maine, is leaning hard toward no. The three would be enough to doom the bill.' Why the Latest Health Bill Is Teetering: It Might Not Work The reason why Republicans are finding it impossible to replace the ACA is because the Act is Republican healthcare reform. Indeed, Paul Ryan’s ‘replacement’ for Medicare is in essence the ACA: the government provides funds for seniors to purchase policies from private insurers. The right’s hostility toward the ACA has nothing to do with the merits of the Act and everything to do with conservatives’ unwarranted hatred of President Obama.