The dramatic overnight defeat of Republicans’ latest, and perhaps final, legislative attempt to repeal the Affordable Care Act (ACA) allows Medicaid patients to continue accessing reproductive health care at Planned Parenthood.

The eight-page “skinny repeal” striking key ACA provisions like the individual and employer mandates dedicated more than two pages to “defunding” Planned Parenthood, even though the nonpartisan Senate parliamentarian determined last week that doing so violated the chamber’s Byrd rule and required a 60-vote threshold for passage. Senate Republicans attempted to skirt the rule by rewriting one of the four criteria blocking Medicaid reimbursements to “prohibited entities” that provide abortion care as part of their reproductive health-care services, despite the longstanding Hyde Amendment blocking federal funds from abortion.

The nonpartisan Congressional Budget Office (CBO) had determined that the criteria applied to Planned Parenthood, and only Planned Parenthood. This time around, “at least two organizations would be affected,” though Planned Parenthood would bear the brunt of the consequences, according to CBO’s estimate of skinny repeal.

The CBO didn’t name the other organization, but Women’s Health Specialists of California raised its hand. The self-described “feminist clinic” called out Senate Republicans for targeting its Medicaid reimbursements in “an absurd attempt to try to prove that they are not targeting Planned Parenthood health centers across this country for political purposes.”

“It is terrifying that this entire process is not being named for what it so clearly is—a politically motivated, targeted effort to undermine women’s access to health care,” Women’s Health Specialists of California said in a statement.

Partisan Strategy Up for Debate

Senate Republicans’ machinations nevertheless could have backfired; as Mother Jones’ Hannah Levintova explained, Women’s Health Specialists of California contested that it no longer meets one of the criteria for prohibited entities.

That would again subject Planned Parenthood alone to defunding, in violation of the Byrd rule.

Cutting off Planned Parenthood from Medicaid reimbursements really means cutting off Medicaid recipients from Planned Parenthood, and for those patients, one year can mean a death sentence. Doing so prevents people with low incomes—especially those in rural communities, per the CBO—from accessing potentially life-saving cancer screenings, sexually transmitted infection testing, contraceptive services, and more at Planned Parenthood affiliates.

The so-called skinny repeal instead provided a $422 million infusion to community health centers that, contrary to GOP talking points, can’t make up the gap in care.

“It’s time politicians learned that they cannot attack women’s health and rights and expect to get away with it,” Planned Parenthood Federation of America President Cecile Richards said in the aftermath of the vote.

Political Theater Ends in Defeat

The 49-51 vote on skinny repeal occurred at 1:24 a.m. after much hand-wringing from Senate Majority Leader Mitch McConnell (R-KY) and Vice President Mike Pence, who was on call in the event of a tie. Some Republicans who voted for the bill openly admitted they hoped it didn’t become law.

GOP Sens. Susan Collins (ME), Lisa Murkowski (AK), and John McCain (AZ) cast the three Republican votes necessary to sink the bill. The Republican women had been consistent in their opposition to Obamacare repeal that targeted Planned Parenthood, overcoming the Trump administration’s threats to retaliate against Alaska if Murkowski voted “no.”

McCain, who was recently diagnosed with brain cancer, this week joined all but Collins and Murkowski in a party-line vote to allow the bill to come to the floor. But in an extraordinary bit of political theater, McCain advised reporters to “watch the show” before heading onto the Senate floor.

After McCain came on floor, he spoke to Cornyn, who appeared upset, turned around and gave a thumbs down to Daines.

— Steven Dennis (@StevenTDennis) July 28, 2017

Sen. Dean Heller (R-NV) voted for the skinny repeal in defiance of his state’s GOP governor, Brian Sandoval. Heller paid lip service to protecting Planned Parenthood during a rowdy April town hall meeting, only for his spokesperson to walk back the pledge a day later.

Heller introduced a non-binding amendment to protect Obamacare’s Medicaid expansion, but it failed, 10-90.

Though the skinny repeal didn’t touch Medicaid, Senate Republicans planned to join their counterparts in the U.S. House of Representatives in negotiating how to undermine the joint federal-state health insurance program for people with low incomes.

McConnell after the vote said it was “time to move on.”.

McConnell attempted to turn to a McCain priority, the House-passed National Defense Authorization Act. Sen. Rand Paul (R-KY), a McCain foe, blocked it.

President Trump slammed Democrats and the trio of Republicans for voting against the health care bill.

“As I said from the beginning, let ObamaCare implode, then deal. Watch!,” he tweeted.

The Obamacare exchanges remain stable despite the Trump administration’s efforts to undermine the marketplace. Trump’s federal agencies wield inordinate regulatory power to unravel Obamacare and reproductive health protections, as Rewire documented in a three-part series.

For now, reproductive health advocates and pro-choice lawmakers alike credit the legislative defeat to activism.

“Tonight, an attempt by President Trump and Republican leaders to spike families’ premiums and deny tens of millions of people health care they depend on failed because of the women, children, patients, and families from all walks of life who made their voices heard—no matter how long the trip to the Capitol was, how frustrated they became, or how frightening it was to speak up,” Sen. Patty Murray (D-WA), the top Democrat on the Senate Health, Education, Labor, and Pensions Committee, said in a statement.

“This may not be the last time we have to fight back against Trumpcare, but we have seen tonight that together, we can fight back and win.”