(CNN) Vulnerable Republican senators split over a bill to protect those with preexisting conditions from a Trump administration lawsuit before the Supreme Court next month, underscoring the political potency of the issue as the country begins voting.
The Senate failed to advance the legislation on Thursday, as all Democrats and six Republican senators voted in favor of it, including five in competitive races: Cory Gardner of Colorado, Joni Ernst of Iowa, Susan Collins of Maine, Martha McSally of Arizona and Dan Sullivan of Alaska. But other Republicans up for reelection, including North Carolina Sen. Thom Tillis, Georgia Sen. David Perdue and Montana Sen. Steve Daines, voted against it. The vote was 51 to 43.
"If President Trump and [the] Republican lawsuit is successful, every single American stands to lose vital health care protections or access to care," warned Senate Minority Leader Chuck Schumer before the vote he forced in a rarely used legislative maneuver.
Protecting the Affordable Care Act is at the center of the Democratic Party's argument for winning back the White House, retaking control of the Senate and blocking the confirmation of Judge Amy Coney Barrett to be on the Supreme Court. Democrats believe she could join with other conservative justices to strike down the ACA after the Trump administration's Department of Justice presents its argument in court a week after Election Day.
Republican leaders attempted to preempt the vote, and protect their vulnerable senators running for reelection, by scheduling a vote Wednesday on a bill authored by GOP North Carolina Republican Sen. Thom Tillis. They said it would maintain protections for those with preexisting conditions should the Supreme Court toss out the ACA.
Senate Democrats blocked that legislation on a party-line vote. Democrats say Republican plans to protect preexisting conditions have fallen short upon close examination, portraying them as political exercises rather than real policy proposals.
At a news conference after the vote, Schumer said he had not misplayed the issue and given vulnerable Republicans an unexpected opportunity to demonstrate their support for preexisting conditions by backing the bill.
"When you flip your vote a few weeks before the election, the American people see right through it. These senators are worse off today no matter how they voted because they flip-flopped," Schumer said. "They can't hide from all their votes to repeal the ACA and this new vote only shows their hypocrisy."
Republicans in Congress have repeatedly voted to repeal and replace the Affordable Care Act. In 2017, Collins, Alaska Sen. Lisa Murkowski, who also voted in favor of the bill on Thursday, and the late Arizona Sen. John McCain opposed the Republican effort to repeal the ACA. But every other Republican supported that vote, as well as dozens of others to undermine the law.
Tillis' office has said that his measure is not meant to be a replacement for the 2010 health law, but "demonstrates the commitment of Republicans to protect Americans with preexisting conditions, regardless of the future of Obamacare."
When Democrats pushed through the health care law along party lines in 2010, it drew scorn from many voters -- and many in their own party distanced themselves from the legislation.
But the bill cut the number of uninsured by about 18 million people, and parts of the ACA are now overwhelmingly popular. This summer, two conservative states, Oklahoma and Missouri, voted for ballot measures to expand Medicaid, a key ACA provision, joining 37 other states.
Republicans in tough races have sought to defend themselves from Democratic attacks on health care. Perdue has even aired an ad featuring his sister, a cancer survivor, as a witness to his desire to protect those with preexisting conditions. The senator voted against the bill on Thursday but in favor of the Republican bill on Wednesday.
"Ultimately, Senate Democrats want to eliminate private health insurance in favor of government-run socialized medicine," said Perdue in a statement on Wednesday. "Bottom line, no matter what happens to Obamacare, the best way to protect people with preexisting conditions and expand access to coverage is through free market solutions, not government-controlled healthcare we know won't work."
This story has been updated with additional developments Thursday.