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WASHINGTON – Arizona’s senators joined all but one of their fellow Republicans early Thursday to narrowly approve a budget resolution that is the first step in overturning the Affordable Care Act.

While Sens. John McCain and Jeff Flake have long opposed “Obamacare,” program advocates criticized the Senate for voting to repeal without offering a plan to cover the millions of Americans who got insurance under the law – as many as 400,000 of them in Arizona.

“Tearing it apart isn’t a solution,” said Caitlin Morris, program director for health system transformation at Families USA.

Her organization, like many advocates, said there is room for improvement in Obamacare and that just repealing it with no plan to replace it is “detrimental to the health of Americans.”

“They should have a conversation about ways to improve it,” Morris said. “Sadly, the conversation is about taking it away.”

McCain and Flake joined 49 other Republicans in the 51-48 vote at 1 a.m. Thursday. Only Sen. Rand Paul, R-Kentucky, crossed the aisle to join Democrats opposing the resolution.

Neither McCain nor Flake was available for comment on the vote Thursday. But in recent months, they have harshly criticized the program that Flake called an “unmitigated disaster in Arizona.”

While hundreds of thousands in the state have received coverage under the plan, premiums skyrocketed this year after many of the private insurers offering coverage pulled out of the state.

Most counties were left with just one provider in the insurance market and premiums in Arizona were expected to rise an average of 116 percent this year, according to estimate last fall from the U.S. Department of Health and Human Services.

Flake last week reintroduced his bill that would expand the use of health savings accounts and give consumers greater control over their health care and health care spending. The bill, which failed to get a vote in the last session of Congress, “ought to be in the conversation as Congress considers options for replacing Obamacare,” Flake said on the floor of the Senate last week.

But supporters of the law, like Morris, said the law should be fixed, not replaced.

Reports of higher premiums ignore the fact that they are offset, in many cases, by federal tax subsidies that are part of the Obamacare law, they said. Families can make up to four times the federal poverty level and still be eligible for some sort of support. For an average Arizona family of four, the cutoff would be an income of about $97,000 per year.

“The less you earn, the more financial assistance, the more you earn the less financial assistance you get,” said Allen Gjersvig, director of navigator and enrollment services at the Arizona Alliance for Community Health Centers.

And supporters warn that straight repeal of the law would have “devastating statewide impacts,” in the words of the Arizona Health Care Cost Containment System. In a presentation from the system this month, it said as many as 600,000 people in the state could lose coverage and the state economy would suffer a severe hit if there was a repeal with no alternatives.

For now, people enrolled for health insurance under Obamacare will have coverage through this year, regardless of what Congress does. And people who had coverage last year can renew through the end of this month.

“The law is the law and it hasn’t been changed,” Gjersvig said.

But Morris said that if Congress acts before 2018 and people are forced to scramble for coverage, that’s not much time. That could mean fewer people enrolling for health insurance, which in turn will mean fewer insurance companies offering policies in the future, she said.

“More uncertainty means less commitment,” Morris said.

DJ Quinlan, a spokesman for the Alliance for Healthcare Security, said “repeal makes the public nervous.

“Congress must show a plan before they repeal,” Quinlan said.

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Web links:

_ Senate vote: http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=115&session=1&vote=00026#position

_ Senate budget resolution: https://www.congress.gov/115/bills/sconres3/BILLS-115sconres3es.pdf

_ Flake bill: http://www.flake.senate.gov/public/_cache/files/a8135e93-6e17-4b18-a447-c03f9b396b92/s.28-health-savings-account-expansion-act.pdf

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Arizona’s senators joined their GOP colleagues to narrowly approve a measure that is the first step toward repealing Obamacare, but advocates worry that repeal could have a “devastating impact” without a plan for replacement coverage. (Photo by Adrian Clark/Creative Commons)