The Senate rejected a Democratic resolution to nullify a Trump administration health care policy that supporters billed as a referendum on support for pre-existing condition protections.

The 43-52 vote on Wednesday blocked a disapproval resolution that would have reversed a 2018 guidance expanding changes states could make to their insurance markets through waivers. Democrats forced the vote via the Congressional Review Act even though no states have sought to make the types of changes the administration is encouraging.

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Sen. Susan Collins, R-Maine, was the sole Republican to vote for the resolution.

Senate Minority Leader Charles E. Schumer, D-N.Y., called the guidance a “horrible rule that threatens the care of millions of Americans with pre-existing conditions” and labeled the debate “one of the most significant policy votes of the year.” The party is expected to try to leverage the vote against Republicans on the campaign trail.

Waivers were included in the Democrats’ 2010 health care law as a way for states to put their own marks on their individual insurance markets. To be granted approval, states had to show their proposals would not decrease the number of people with insurance coverage and that their coverage would be as comprehensive and as affordable.

The Centers for Medicare and Medicaid Services issued the revised guidance, which said states would have to show an equivalent number of residents would have access to some form of coverage under the waiver, including plans that don’t meet the health law’s requirements.

The agency also released a list of policy ideas for states to consider, such as allowing people to use federal subsidies to buy short-term plans that do not have to guarantee coverage for people with pre-existing conditions or cover essential benefits required under the law.

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The White House issued a veto threat Monday against the resolution. 

Democrats previously forced a vote on the administration’s rule expanding the duration of short-term plans. Collins also was the only Republican to disapprove of the rule at that time.

The Government Accountability Office said earlier this year the guidance could be considered a rule, allowing Democrats to hold Wednesday’s vote.

Democrats say it is important to vote to rescind the policy although no state has pursued these changes.

“If Trump is successful in continuing to push forward these rules, he’s going to also start to put pressure on Republican governors to join him,” Connecticut Democratic Sen. Christopher S. Murphy said. “It’s just a matter of time before he starts tweeting at Republican governors to move forward with their own plans to undermine the Affordable Care Act.”

Senate Majority Leader Mitch McConnell, R-Ky., said Tuesday on the Senate floor that the Trump administration has said a waiver could not undermine protections for people with pre-existing conditions.

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“Apparently our Democratic colleagues are not terribly fond of letting states shake off the unhelpful structures of Obamacare,” McConnell said. “Perhaps it makes their signature law look bad that governors of both parties are eager to escape from it.”

McConnell noted that a dozen states have used the waivers to set up reinsurance programs to receive government funds to cover the highest-cost patients. Those waivers were not affected by the Trump administration’s changes in the guidance memo. Both Republican and Democratic governors have set up such programs, which have led to lower premiums in those states.

On Wednesday, Senate Health, Education, Labor and Pensions Chairman Lamar Alexander, R-Tenn., objected to two unanimous consent requests from Sen. Tammy Baldwin, D-Wis., to bring up a bill that would reverse the administration’s short-term plan rule and another to authorize additional funding for the navigator program to help people enroll in insurance coverage.