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WASHINGTON – The Senate defeated a resolution Wednesday that would have overturned a Trump administration rule that lets states extend short-term health insurance policies for up to three years as a substitute for traditional coverage.

The short-term policies do not cover pre-existing conditions and require no minimal protections and place no limits on deductibles or copays.

Fifty-two senators, all Republicans, voted to leave the rule in place after a debate over how it would affect Americans. Only Maine Sen. Susan Collins broke ranks with her party.

Forty-three Senate Democrats, including Amy Klobuchar and Tina Smith of Minnesota, voted to overturn the short-term extension rule. Five Democrats did not vote. Ironically, the five ­— Elizabeth Warren, Bernie Sanders, Cory Booker, Kamala Harris and Michael Bennet — are all running for the Democratic presidential nomination, where health care is a major issue.

Those who wanted to overturn the short-term extension rule said it left unsuspecting citizens open to financial ruin and was an attempt by the White House to undermine the individual insurance market set up by the Affordable Care Act (ACA).

Those who voted to uphold states' rights to short-term policy extensions said they provided an affordable alternative to more expensive ACA policies, which guarantee insurance coverage for people with pre-existing medical conditions, as well as basic benefits.

The resolution to overturn the policy fell short, as did a similar measure last year that failed on a 50-50 vote.

Republicans picked up seats in the 2020 midterm elections that added to their majority in the Senate in the current vote.

The debate before Wednesday's vote was one of dual narratives.

Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, said the resolution's supporters exaggerated the dangers of short-term policy extensions.

Overturning the extension rule would "take away a lower-cost option from 1.7 million" Americans, he said. Alexander credited the policy extensions with leading to reduced premiums, including a 20% reduction in rates in Minnesota.

Virginia Democratic Sen. Mark Warner, who forced the vote through a parliamentary maneuver, told the story of a constituent who bought a short-term policy as a cheaper alternative to ACA-approved policies. Warner said the man ended up with a $231,000 bill for back surgery because he was determined to have a pre-existing condition that did not qualify for benefits.

Fearing similar situations, many states, including Minnesota, have set time limits on short-term policies. In Minnesota, the stopgap policies can run no longer than six months with a single six-month renewal within two years.

Minnesota-based UnitedHealthcare sells short-term limited duration policies. A company spokesman pointed to a Congressional Budget Office study that showed half a million people could end up uninsured if states are not allowed to extend short-term policies. But he also said short-term health insurance policies are supposed to bridge a gap in conventional health insurance and "are not intended to replace ACA coverage."

UnitedHealthcare, the spokesman said, encourages customers to understand the limits.

"The plans generally do not cover pregnancy, treatment of mental disorders or substance abuse," he said. "They are medically underwritten and can contain certain exclusions or limitations, including pre-existing condition limitations, that may not make them an appropriate choice."

Jim Spencer • 202-662-7432