GOP clears health law hurdle in Senate

Pence breaks tie to open debate on repealing Obamacare

WASHINGTON — Republicans narrowly advanced their campaign to roll back the Affordable Care Act on Tuesday, as the Senate voted by a slim margin to begin debating legislation to repeal and potentially replace large sections of the 2010 law signed by President Barack Obama.

But the partisan 51-50 vote — with Vice President Mike Pence breaking a tie — does not ensure the success of the GOP’s sevenyear quest to dismantle the sweeping law, often called Obamacare.

With health coverage for tens of millions of Americans at stake, it remained unclear Tuesday what kind of health care bill, if any, might emerge by the time a final Senate vote is held, possibly as early as Thursday.

Senate Majority Leader Mitch McConnell, R-Ky., has set up a series of votes this week on competing proposals to repeal much of Obamacare, or repeal and replace pieces of the law. The first one, to consider what had been seen as the GOP’s leading replacement proposal, failed Tuesday evening by a vote of 43-57, with nine Republicans voting against it.

Tuesday’s procedural vote to kick off that process marked a victory for McConnell, who has been laboring for months behind closed doors to rally his divided caucus, and for President Donald Trump, who has been publicly calling on GOP senators to stick with the repeal push.

Trump praised the Senate vote as a “big step” during a news conference at the White House. “We’re going to give you great health care,” he said, adding Republicans would “over the next week or two, come up with a plan.”

To get to this point, McConnell had to abandon the customary legislative process, foregoing public hearings and committee debate in a way almost never seen for major legislative proposals. And he left Republican lawmakers with a series of legislative options — which polls show are unpopular with Americans — that would leave as many as 32 million more people without health coverage and weaken health protections for tens of millions more.

The GOP plans have been widely panned by independent analysts and opposed by every major patient advocacy group and leading organization representing physicians, nurses and hospitals.

Before the vote, Senate Minority Leader Chuck Schumer, D-N.Y., pleaded with GOP lawmakers in the Senate chamber to stop their repeal rush and work with Democrats on bipartisan fixes to the current law.

As voting began, protesters filled the gallery, chanting “Kill the bill!” and “Shame!” before being escorted out of the chamber.

The proceedings came to a momentary standstill as Sen. Ron Johnson, R-Wis., who had yet to vote, huddled at McConnell’s desk. But Sens. Susan Collins of Maine and Lisa Murkowski of Alaska were the only Republicans who voted against the motion.

In a moment of drama, senators waited at their desks for the return of Sen. John McCain, R-Ariz., following his surgery last week and a diagnosis of brain cancer. He arrived in the chamber to cheers and a standing ovation from his colleagues before casting a critical vote to back McConnell.

He then delivered a speech criticizing the process the Republican leader has used to push the repeal legislation forward and called for more bipartisanship. “Why don’t we try the old way of legislating in the Senate, the way our rules and customs encourage us to act?” McCain said. “If this process ends in failure, which seems likely, then let’s return to regular order.”

Democrats waited until Republicans had finished voting, before casting theirs, all of them opposed. Patient advocates and health care groups condemned the vote.

As Republicans move to crafting a final bill, one leading GOP option, favored by conservatives, is to repeal major parts of Obamacare, then try to pass a new health care law in the future.

McConnell is also expected to offer a revised version of the Republican bill, the Better Care Reconciliation Act, which would replace most of the law while scaling back federal funding of the Medicaid insurance program that covers 74 million low-income, elderly and disabled Americans.

So far, neither of these approaches has garnered the necessary 50 votes from the Republicans’ 52-seat Senate majority, and that math does not appear to have changed.

Tuesday evening, leaders offered their first amendment, which was the BCRA with two provisions added — one from Sen. Ted Cruz, RTexas, to allow health insurers to sell skimpier plans that do not include basic benefits such as prescription drugs and maternity care, and one from Sen. Rob Portman, ROhio, to add $100 billion to help those losing Medicaid.

That package failed to reach the 60-vote threshold for passage under budget rules.