Update: With Vice President Mike Pence breaking a 50-50 tie, the Senate voted by a hair Tuesday to start debate on repealing the Affordable Care Act, better known as Obamacare.
The vote gives President Trump and GOP leaders a crucial initial victory but launches a weeklong debate promising an uncertain final outcome. The 51-50 vote kept alive hopes of delivering on promises that countless Republican candidates have campaigned on for years — repealing President Obama's 2010 health care overhaul. It also averted what would have been a blistering defeat for a party divided between fervent conservatives demanding the evisceration of Obama's statute and centrists intent on not pulling coverage away from millions of Americans.
Pence presided over the Senate during the vote, which began after dozens of protesters shouted "kill the bill" and "shame" from the chamber's visitors' gallery.
Moderate Sens. Susan Collins and Lisa Murkowski were the only Republicans to defect from their party's quest. Their complaints about the legislation had included its cuts in Medicaid, the health insurance program for the poor, the disabled, and nursing home residents.
Not a single Democrat backed the effort to overthrow Obama's signature domestic legislative achievement. In an unusual move, most of them sat in their states during the climactic roll call, eyeing Republicans as they cast their votes.
Technically, Tuesday's vote meant the Senate would consider a measure the House approved in May eliminating much of Obama's statute. Like legislation McConnell crafted mostly behind closed doors — and has since revised — it would eliminate Obama's tax penalties on people not buying policies, cut Medicaid, erase many of the law's tax boosts, and provide less generous healthcare subsidies for consumers.
But now, the Senate faces 20 hours of debate and a long parade of amendments, and if a measure eventually emerges, it is likely to look quite different. Because the chamber's moderates and conservatives are so riven over how to replace Obama's overhaul, leaders have discussed passing a narrow bill repealing only some unpopular parts of that law — like its penalties on individuals who eschew coverage — with the ultimate goal being to negotiate a final package with the House.
This story was originally published on July 25, 2017 at 9:40 a.m.
President Trump urged Republicans to "step up to the plate" for Tuesday's crucial Senate healthcare vote on their bill eviscerating much of the Affordable Care Act. The stage was set for high drama, with Sen. John McCain returning to the Capitol to cast his first vote since being diagnosed with brain cancer.
The senator announced through his office that he would be back in Washington for the critical roll call on beginning debate on the legislation. Should the initial motion win, that would prompt 20 hours of debate and countless amendments in a battle likely to last all week.
McCain has been at home in Arizona since he revealed last week that he's undergoing treatment for brain cancer, but a statement said he "looks forward" to returning for work on healthcare and other legislation.
Senate Majority Leader Mitch McConnell scheduled the initial healthcare vote for Tuesday. It seemed unlikely Republicans would bring McCain cross country if they didn't think his vote would make a difference, and his mere presence could make it harder for wavering Republicans to cast a vote against even considering the bill.
Democrats uniformly oppose the effort to tear down Obama's signature legislative achievement. Republicans control the chamber 52-48, meaning they can afford to lose just two Republicans with McCain around, and only one in his absence. Vice President Mike Pence would cast a tie-breaking vote.
Trump kept up the pressure on GOP lawmakers, tweeting on Tuesday that "After 7 years of talking, we will soon see whether or not Republicans are willing to step up to the plate!" He added: "ObamaCare is torturing the American People. The Democrats have fooled the people long enough. Repeal or Repeal & Replace! I have pen in hand."
Senators and aides said talks were continuing that might win over enough Republicans to commence debate. The discussions were covering issues including potentially giving states more leeway to use federal funds to help people losing coverage under Medicaid, the health insurance program for the poor, disabled, and nursing home patients.
Should Tuesday's vote fail, it would be an unalloyed embarrassment for a party that finally gained control of the White House, Senate, and House in January but still fell flat on its promise to uproot Obamacare. Republicans could try returning to the bill later this year if they somehow round up more support.
If the vote passes, moderate and conservative Republicans would try reshaping the bill in their direction while Democrats would attempt to force GOP senators to cast difficult votes aimed at haunting them in re-election campaigns.
Even then, the measure's ultimate fate still seems iffy because of internal divisions.
President Obama's signature law was enacted in 2010 over unanimous Republican opposition. Since then, its expansion of Medicaid and creation of federal insurance marketplaces has produced 20 million fewer uninsured people. It's also provided protections that require insurers to provide robust coverage to all, cap consumers' annual and lifetime expenditures, and ensure that people with serious medical conditions pay the same premiums as the healthy.
The law has been unpopular with GOP voters and the party has launched numerous attempts to dismantle the statute. All until this year were mere aspirations because Obama vetoed every major one that reached him.
Ever since 2010, Republicans have been largely united on scuttling the statute but divided over how to replace it.
Those divides sharpened with Trump willing to sign legislation and estimates by the nonpartisan Congressional Budget Office that each GOP bill would cause more than 20 million people to become uninsured by 2026. Polls showing growing popularity for Obama's law and abysmal approval ratings for the GOP healthcare bills haven't helped.
McConnell's bill would abolish much of Obama's law, eliminating its tax penalties on people not buying policies, cutting Medicaid, eliminating its tax boosts on medical companies, and providing less generous healthcare subsidies for consumers. The measure would also defund Planned Parenthood for a year, even though the U.S. Senate’s Office of the Parliamentarian ruled on Friday that the provision may be breaking the Senate's budget reconciliation rules.
Moderate Sen. Susan Collins has remained opposed to beginning debate on any option McConnell has revealed so far. Conservative Sen. Rand Paul said he would vote no unless leaders agreed to an early vote on simply repealing Obama's statute and giving Congress two years to replace it.
Conservatives were seeking language letting insurers offer bare-bones policies with low premiums, which would be illegal under Obama's law. Moderates from states whose low-income residents rely heavily on Medicaid were resisting the GOP bill's cuts in that program.