Pittsburgh Post-Gazette

By a hair, Senate votes to debate GOP health bill

Lawmakers later reject repeal proposal

- By Alan Fram

WASHINGTON — Prodded by President Donald Trump, a bitterly divided Senate voted at last Tuesday to move forward with the Republican­s’ long-promised legislatio­n to repeal and replace “Obamacare.” There was high drama as Sen. John McCain returned to the Capitol for the first time after being diagnosed with brain cancer to cast a decisive “yes” vote.

The final tally was 51-50, with Vice President Mike Pence breaking the tie after two Republican­s joined all 48 Democrats in voting “no,” and it came only a week after the Republican effort to dismantle a pillar of former President Barack Obama’s legacy appeared all but doomed.

It was seen as an initial win for Mr. Trump, who pushed, cajoled and threatened senators in recent days to at least begin debating the repeal of the health care law. Even as the upper chamber’s Republican­s still had no agreement on a repeal bill, the Senate was moving ahead with debate, amendments and ultimately a final vote in the coming days on legislatio­n that would have a profound effect on the American health care system — roughly one-sixth of the U.S. economy — and how tens of millions of Americans receive medical care.

But hours after Republican­s overcame deep divisions to bring their proposals up for debate, those same schisms were spotlighte­d when Senate Republican leaders Tuesday night failed to pass a bill that they spent weeks crafting but never gained sufficient traction with the rank-and-file. Fifty-seven senators — including nine defecting Republican­s — opposed the measure known as the Better Care Reconcilia­tion Act, while 43 supported the wide-ranging proposal to repeal much of Obamacare and replace it with a more restrictiv­e plan.

The rejected proposal included language by Senate Majority Leader Mitch McConnell of Kentucky erasing the Obama law’s tax penalties on people not buying insurance and cutting Medicaid.

Language by Texas Republican Sen. Ted Cruz would let insurers sell cut-rate policies with skimpy coverage. And there was an additional $100 billion to help states ease costs for people losing Medicaid sought by Midwestern moderates.

With all senators in their seats and protesters agitating outside and briefly inside the chamber, Tuesday afternoon’s vote was held open at length before Mr. McCain, 80, entered the chamber. Greeted by cheers, he smiled and dispensed hugs — but with the scars from recent surgery starkly visible on the left side of his face.

Despite voting “yes,” he took a lecturing tone afterward and hardly saw success assured for the legislatio­n after weeks of

misfires, even after Tuesday afternoon’s victory for Mr. Trump and Mr. McConnell.

“If this process ends in failure, which seems likely, then let’s return to regular order,” Mr. McCain said as he chided Republican leaders for devising the legislatio­n in secret along with the administra­tion and “springing it on skeptical members.”

“Stop listening to the bombastic loudmouths on the radio, TV and internet. To hell with them!” Mr. McCain said, raising his voice as he urged senators to reach for the comity of earlier times.

At the White House, though, Mr. Trump wasted no time in declaring a win and slamming the Democrats anew.

“I’m very happy to announce that, with zero of the Democrats’ votes, the motion to proceed on health care has just passed. And now we move forward toward truly great health care for the American people,” Mr. Trump said. “This was a big step. I want to thank Senator John McCain — very brave man.”

The health care debate is expected to spark a chaotic, unpredicta­ble couple of days on Capitol Hill. Republican­s remain sharply divided over the details of the repeal process. It remained unclear Tuesday what kind of health care bill — if any — might emerge by the time a final Senatevote is held.

At its most basic, the Republican legislatio­n is aimed at undoing Obamacare’s unpopular mandates for most people to carry insurance andbusines­ses to offer it. The GOP would repeal Obamacare taxes and unwind an expansion of the Medicaid program for the poor, the disabled and nursing home residents The result would be 20 million to 30 million people losing insurance over a decade, depending on the version of the bill.

Tuesday afternoon’s vote amounted to a procedural hurdle for legislatio­n whose final form is impossible to predict under the Senate’s byzantine amendment process, which will unfold over the next several days.

Indeed senators had no clear idea of what they would ultimately be voting on, and in an indication of the uncertaint­y ahead, Mr. McConnell said the Senate will “let the votingtake us where it will.”

Yet after seven years of empty promises, and weeks of hand-wringing and false starts on Capitol Hill, it was the Senate’s first concrete step toward delivering on pledges to undo Mr. Obama’s law. It came after several near-death experience­s for earlier versions of the legislatio­n, and only after Mr. Trump summoned senators to the White House last week to order them to try again after Mr. McConnell had essentiall­y conceded defeat.

Democrats stood implacably opposed, and in an unusual maneuver they sat in their seats refusing to vote until it was clear Republican­s would be able to reach the 50-vote margin needed to get them over the top with Mr.Pence’s help.

Several GOP senators who’d announced they would oppose moving forward with the legislatio­n reversed themselves to vote “yes.” Among them were Dean Heller of Nevada, Shelley Moore Capito of West Virginia and Ron Johnson of Wisconsin.

The two Republican­s voting “no” were Susan Collins of Maine and Lisa Murkowski of Alaska.

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