"Introduction States as Stakeholders After the November 2016 elections gave the Republican Party unified control over the presidency and both chambers of Congress, its long-standing goal of "repealing and replacing" the Patient Protection and Affordable Care Act (ACA) seemed to be well within its reach. The House of Representatives voted to eradicate the central domestic policy accomplishment of the Obama administration in early May, at which point all eyes turned to the Senate. Since Senate Republicans were using the reconciliation process to circumvent the possibility of a Democratic filibuster and held only a 52-48 majority in the chamber, media attention focused on the handful of GOP senators viewed as capable of bucking the party line"--
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