On Tuesday, September 29, 2026, Senate Republicans voted to keep a Trump administration rule that makes Obamacare coverage harder to get and more expensive to use. Democrats forced a vote to scrap the rule, and it failed, 48 to 51.

Voting yes meant scrapping the rule. Voting no meant keeping it.

Only one Republican voted yes: Maine's Susan Collins. Every other Republican who voted said no, and thirteen of them have report cards on this site.

What the rule does

Obamacare is still the law, so every year the administration in power writes the rules for running it, including this one. This rule sets 2027's requirements for the Obamacare marketplaces, where people who don't get insurance through work buy their own. Its official name is the "Notice of Benefit and Payment Parameters for 2027," and the Trump administration finalized it on May 15.

The administration's own Department of Health and Human Services estimates the rule could cut marketplace enrollment by 1.2 million to 2 million people, according to the Health Management Associates summary of the final rule. That isn't a Democratic estimate. It's the government's own.

The rule does three main things, according to The Washington Sun:

• More paperwork to keep your coverage. Tighter income checks and new eligibility checks for people enrolled in marketplace plans.
• Plans that cost you more when you get sick. New plans with higher limits on what you pay out of your own pocket.
• Plans with no network of doctors. Coverage that doesn't come with a set group of doctors and hospitals that have agreed to its prices.

Senator Tammy Baldwin, who forced the vote, laid out what the higher limits mean. Under the rule, a bronze plan could leave one person paying up to $15,600 out of pocket in 2027, or a family $31,200, before the plan covers everything. She noted that is "almost the entire income of an individual earning at the federal poverty level," according to her office. Her office also said the extra paperwork would hit 4.7 million people, and coverage for things like substance use treatment and hearing aids could shrink in many states.

A judge has paused part of it, for now

On July 16, a federal judge in Maryland paused eight parts of the rule, including the higher out-of-pocket limits on some bronze and catastrophic plans and the new plans with no network of doctors. The judge found the challengers were likely to win their case. The rest of the rule took effect on July 20.

That pause is temporary. If the administration wins in court, those parts come back. Scrapping the rule would have ended all of it for good. These Republicans voted to keep it, including the parts a judge has already said are likely unlawful.

Who voted to keep it

Republicans did not even argue for the rule. "No Republicans spoke against the measure in brief debate before the vote," The Washington Sun reported. They just voted to keep it.

These are the thirteen Republicans on this site who voted no:

• Tom Cotton of Arkansas
• Ashley Moody of Florida
• Jim Risch of Idaho
• Roger Marshall of Kansas
• Cindy Hyde-Smith of Mississippi
• Pete Ricketts of Nebraska
• Jon Husted of Ohio
• Darline Graham of South Carolina
• Mike Rounds of South Dakota
• Bill Hagerty of Tennessee
• Shelley Moore Capito of West Virginia
• Tommy Tuberville of Alabama, who is running for governor
• Marsha Blackburn of Tennessee, who is also running for governor

Alaska's Dan Sullivan, who is also on this site, did not vote.

Not the first time

Last December, Senate Republicans blocked an extension of the tax credits that had kept marketplace premiums down. As we reported in August, those credits expired and marketplace enrollment fell 12% nationwide, by 2.6 million people.

Roger Marshall is an OB-GYN who sits on the Senate's health committee. He voted against extending those credits last year, and he voted to keep this rule now. Darline Graham spent her career working with disabled South Carolinians, and her first Senate votes on health care went against them too.

So first the help paying premiums went away, and 2.6 million people dropped their coverage. Now these thirteen have voted to keep a rule the administration expects will push up to 2 million more off. The people who stay face more paperwork, and if the administration wins in court, plans that can leave them paying far more before their insurance covers everything.

In summary

On September 29, thirteen Republican senators tracked on this site voted to keep a Trump administration Obamacare rule that HHS itself estimates could cut marketplace enrollment by 1.2 million to 2 million people. The rule adds paperwork to stay covered. A federal judge has paused its most expensive parts, including bronze plans that could leave one person paying up to $15,600 a year out of pocket, but only until the court case ends. Susan Collins was the only Republican who voted to scrap it.

Source

Senate Roll Call Vote 251, 119th Congress, 2nd Session (September 29, 2026), with reporting from InsideHealthPolicy and The Washington Sun.