For the last seven years, Republican leaders have engaged in a fraudulent campaign against the A.C.A. based on the lie that the law is either unworkable or collapsing. The law, which is based on conservative market-based ideas, is certainly flawed and could be improved, but it has helped 20 million people gain insurance and, as a result, provided needed medical care to the poor and the sick. Not only was the Republican diagnosis wrong, but also leaders like the House speaker, Paul Ryan, and the Senate majority leader, Mitch McConnell, tried to push through legislation that was devoid of any ideas and would have weakened the health care system and left millions unable to afford health care. One telling sign: Insurance companies, hospitals, doctors and public interest groups like AARP opposed pretty much every proposal the Republicans put out over the last seven months.
Ultimately, this deceitful campaign ran aground by the narrowest of margins in the Senate thanks to the three Republicans and all 48 Democrats and independents. Much attention has rightly focused on Mr. McCain. Returning to the Senate after surgery and a brain cancer diagnosis, he delivered a stirring speech on Tuesday calling on lawmakers from both parties to reach “agreements made in good faith that help improve lives and protect the American people.” He seemed to go against those sentiments early in the process when he voted to start debate. But, when it really counted, Mr. McCain did the right thing. An equal or larger amount of credit ought to go to Ms. Collins and Ms. Murkowski, who stood firm despite immense political pressure and, in Ms. Murkowski’s case, shameful threats by the Trump administration.
Or the administration could decide to work with Congress and state governments to improve the law. Congress could strengthen the insurance market by voting to make the subsidy payments, which it never explicitly did. The 19 states that have not expanded Medicaid could reconsider and help four million more people gain health insurance. And the administration and state governments could enact reinsurance programs and other policies to lower the risk to insurers and encourage them to sell coverage in rural and suburban areas.
After this failure, Republicans must figure out whose example they will follow. They can adopt Mr. Trump’s call for yet another scorched-earth campaign. Or they can listen to the likes of Mr. McCain about the benefits of bipartisanship and cooperation.