With the prospects of an immediate repeal of the Affordable Care Act apparently dead, Robert Dean, a Fort Worth, Texas, web consultant, said Tuesday he’s “stuck in a broken system.”

Dean and millions of others who make too much to qualify for Affordable Care Act subsidies, had been hoping to get relief from the skyrocketing insurance premiums that cost his family almost $1,100 every month.

But when Republican senators Mike Lee, of Utah and Jerry Moran of Kansas, announced Monday night they would not support the Senate’s health care bill, Majority Leader Mitch McConnell acknowledged the bill “will not be successful.”

Lee and Moran’s announcement brought to four the number of senators opposing the bill. Republicans could afford only two defections.

McConnell quickly began floating the idea of simply repealing the law after a two year transition period. But it’s unclear if Republicans have enough votes for even that fallback position.

The Congressional Budget Office estimated in January that repeal would lead to 32 million more uninsured over the next decade — 10 million more than the Senate bill. West Virginia Republican Sen. Shelley Moore Capito said Tuesday she wouldn’t vote to repeal the law without a replacement because it would end funding to expand Medicaid to more people in her state.

But struggling to afford insurance, and help uncertain, Dean was angry.

“It’s extremely disappointing Republicans told the American people they were going to get rid of the broken system, and the Senate can’t get its act together,” said Dean, a Republican, who was touted as a “victim of Obamacare” at a meeting with Vice President Mike Pence last month.

“Now the gridlock is owned by the Republicans,” he said.

However, if Congress does nothing, others would benefit, health care experts said.

Low-income people who do qualify for subsidies would not face the higher premiums or deductibles in the Senate bill.

Unknown is whether conservatives will be able to reduce Medicaid spending, both for the very low-income and for about 14 million who gained coverage when 32 states, including the District of Columbia, expanded the program to those making slightly more

Inaction would mean they’d continue getting coverage at little or no cost.

No action, though, would affect those making between the federal poverty level and four times the level — between $20,420 to $81,680 for a family of three. They qualify for subsidies to help pay for premiums.

Congress’ debate comes as insurers have been submitting preliminary rate increases for next year — as high as 30 percent in Kentucky, more than 40 percent in Tennessee and 50 percent in Georgia, McConnell said.   

Those receiving subsidies are shielded from the rate hikes because they are guaranteed of paying only 9.9 percent of their income on premiums. The subsidies make up the difference and cover any rate increase.

However, if Congress is unable to provide reassurances the insurance industry wants, more insurers could stop selling subsidized insurance.  

According to the Kaiser Family Foundation, 38 counties in Indiana, Ohio and Nevada could have no insurer offering subsidized plans next year. That could mean 24,525 people could qualify for subsidized plan but have no way to buy them.

Industry groups like America’s Health Insurance Plans have been lobbying for a commitment to enforce the current law’s requirement to have insurance. They argue that if younger, healthier people do not get coverage it would drive up costs for those who have medical issues.

Insurers also want the federal government to continue paying a subsidy to lower deductibles and copayments, saying that if cost-sharing goes up people will drop their coverage.

The Senate plan would have continued the subsidy for two years. It would also get rid of the mandate to have insurance. But it would have created new incentives to get coverage, like making people wait six months to get subsidized insurance if they hadn’t had coverage.

If Congress cannot pass health care legislation, much will depend on Trump. While the mandate to be insured would not be repealed, it’s unknown if the administration would enforce it or continue paying the subsidies, said Eliot Fishman, senior director of health policy at Families USA, a group supportive of the current health care law.

And Trump on Tuesday posted on Twitter that, “As I have always said, let ObamaCare fail.”

However, the greatest impact if Congress fails to act could be for those like Dean who do not get subsidies and could face even higher premiums next year.

Pennsylvania insurance commissioner Teresa Miller, for example, said last month that the five insurers selling subsidized insurance in the state are seeking an average 8.8 percent rate increase.

But quoting them, she said, the increase would be 20.3 percent if Congress or the Trump administration stops paying the cost-sharing subsidy. Rates would rise 23.3 percent if the government stops enforcing the requirement to have insurance.

No action would also kill a provision in the bill that would have allowed Dean to buy cheaper insurance.

The idea, offered by  Sen. Ted Cruz, R-Texas, would have allowed people to  buy a cheap bare-bones plans instead of the more expensive and comprehensive insurance now required.

Karen Pollitz, a Kaiser health care expert, acknowledged Cruz’s amendment would mean “eye-poppingly low premiums” for the young or healthy.

But they wouldn’t cover much. Pollitz said those buying cheaper plans could find themselves deep in debt should they need medical care.

At the same time, those who want more coverage for things like maternity or mental health care or prescription drugs would have faced much higher premiums.

But Dean said he could have bought only what he needed. “Some families don’t have to buy the Cadillac version,” he said. “My mom doesn’t need obstetric coverage.”

He said people should have the choice. But now that seems less likely.

Contact Washington reporter Kery Murakami at kmurakami@cnhi.com.