Republican leaders were stung by another defeat Wednesday when the Senate rejected a repeal of the Obamacare law and its mandates on coverage, taxes and Medicaid expansion.

In a letter to Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Charles Schumer (D-N.Y.), the governors write that the “skinny” repeal is “expected to accelerate health plans leaving the individual market, increase premiums, and result in fewer Americans having access to coverage.”

Nevadans who receive medical insurance through the Silver State Health Insurance Exchange could see the average proposed rate increase 38 percent for the individual market by 2018, according to a press release.

On July 24, 2017, the Internal Revenue Service finalized proposed and temporary regulations governing Affordable Care Act (ACA) premium tax credits that had been issued in July of 2014. Except for one minor technical change, the 2014 proposed and temporary rules are adopted unchanged. The temporary regulations were apparently about ready to expire. The preamble to the regulation rejects a number of suggestions to extend the earlier rules, but does so in a calm and reasonable manner that is almost jarring given the current inflamed rhetoric surrounding the ACA. Until the ACA is amended, it is still the law of the land and the IRS is going to make it work.

Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a “skinny repeal” that rolls back an unpopular portion of the federal health law. But experts warn that the idea has been tried before, and with little success.

Faced with uncertainty around the federal government's commitment to pay out funds meant to help consumers afford coverage on Affordable Care Act exchanges, state insurance commissioners are being put in the position to guess the future. If they make the wrong choice, their residents could find themselves without coverage and the ability to access care.