On Tuesday, September 29, 2026, the Senate voted on whether to take up a resolution undoing a Trump administration rule that makes Obamacare coverage harder to get and more expensive to use. Republicans voted it down, 48 to 51.

Every Republican who voted said no except one, Maine's Susan Collins. Thirteen of the Republicans who voted to keep the rule have report cards on this site.

What the rule does

The rule has a dull name: the "Notice of Benefit and Payment Parameters for 2027." It sets the rules for the Obamacare marketplaces, where people who don't get insurance through work buy their own. The Trump administration finalized it on May 15.

Here is the part that matters. 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 is not a Democratic talking point. It is the government's own math.

The rule does that in a few ways, 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 the numbers. Under the rule, a bronze plan could make one person pay up to $15,600 out of pocket in 2027 before coverage fully kicks in, or $31,200 for a family, which she noted is "almost the entire income of an individual earning at the federal poverty level," according to her office. Her office said more paperwork would land on 4.7 million people, and coverage for things like substance use treatment and hearing aids could shrink in many states.

A judge already blocked part of it

Some of the worst parts of this rule are on hold, and not because of anything these senators did. On July 16, a federal judge in Maryland paused eight provisions, including the bigger out-of-pocket limits on some bronze and catastrophic plans and the new no-network plans. The judge found the challengers were likely to win their case. The rest of the rule took effect on July 20.

So the court did half of what Baldwin's resolution would have done, and the Senate had the chance to finish the job and make it permanent. Instead, these Republicans voted to keep the whole rule on the books, including the pieces a judge had already found likely to be unlawful. If the administration wins on appeal, those come right back.

Who voted to keep it

On the floor, 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 it down.

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.

The second time this year

This is not the first time Senate Republicans have voted to make this insurance cost more. Last December, they 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.

Now, with the tax credits gone, these thirteen have voted to keep a rule that the administration itself expects will push up to 2 million more people off their coverage. The people who stay are being asked to file more paperwork and, if the administration wins in court, to accept plans that can leave them paying far more before their insurance pays its share.

In summary

On September 29, thirteen Republican senators tracked on this site voted to keep a Trump administration Obamacare rule that HHS estimates could cut marketplace enrollment by 1.2 million to 2 million people. The rule adds income checks, and its plans with out-of-pocket costs up to $15,600 a person are among the parts a federal judge has paused as likely unlawful. Susan Collins was the only Republican who voted to take up the resolution repealing it.

Source

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