Dramatic Senate Vote Pushes Health Care Reform Effort Forward

WASHINGTON, DC — Senate Republicans secured the votes to move forward with efforts to repeal Obamacare Tuesday — even as GOP leadership has made little public about its plans. With the initial vote in the Senate split 50-50, Vice President Mike Pence cast the deciding vote. Senators will still need to vote on a substantive bill.

So far, the Congressional Budget Office has estimated that any GOP plan would spike the uninsured rate in the United States over the next decade.

Sen. Lisa Murkowski of Alaska and Sen. Susan Collins of Maine were the only Republicans to vote no on the measure. All Democrats voted against the motion to proceed. (For more information on this and other political stories, subscribe to the White House Patch to receive daily newsletters and breaking news alerts.)

Republican Sen. John McCain of Arizona, still recovering from surgery and newly diagnosed with an aggressive form of brain cancer, returned to the Senate for the vote.

After the vote, McCain took to the floor to disparage the process that led to the measure passed today. He decried the fact that the GOP health care bills considered so far have been crafted in secret and said he does not support recent versions of the legislations.

"I will not vote for the bill as it is today," he said, punctuating each word emphatically. "It’s a shell of a bill right now, we all know that."

He also spoke fondly of the Senate as an institution and thanked his colleagues for the kind words they've said about him in recent days. When he finished, he received a standing ovation.

On Twitter, President Trump said to McCain: "Thank you for coming to D.C. for such a vital vote. Congrats to all Rep. We can now deliver grt healthcare to all Americans!"

In a prepared statement, Trump said, "As this vote shows, inaction is not an option, and now the legislative process can move forward as intended to produce a bill that lowers costs and increase options for all Americans. The Senate must now pass a bill and get it to my desk so we can finally end the Obamacare disaster once and for all."

Collins, who voted against the motion to proceed, explained her dissent from the party line on Twitter:

Republican Sen. Shelley Moore Capito of West Virginia initially expressed doubts about voting for Tuesday's motion.

"I remain committed to reforming our health care system while also addressing the concerns I have voiced for months," she said. "I will continue to push for policies that result in affordable health care coverage for West Virginians, including those who are in the Medicaid population and those struggling with drug addiction."

Marianna Sotomayor of NBC News reported that Republican Sen. Dean Heller of Nevada, another skeptic of GOP health care designs, said that party leadership wants to vote on a bill by Friday. "Let's put this behind us," he told her.

Ahead of the vote, protesters against GOP health care legislation chanted "Shame!" and "Kill the bill!"

Democrats universally voted against the measure. A group of the minority party lawmakers spoke to protesters outside the Capitol building after the vote:

"This is a disgrace," Sen. Bernie Sanders of Vermont said of the vote. "It is insulting. And it is undemocratic."

The motion passed Tuesday technically brings the American Health Care Act, the bill passed by the House, to the Senate floor. Once the bill, which has been called dead on arrival in the Senate, is up for debate, Republicans can vote on the Senate's alternative, the Better Care Reconciliation Act, or a simple repeal of Obamacare's funding. Neither of these plans appear to have enough support to pass, though.

If Republicans do vote on BCRA, one big outstanding question is whether it will include Sen. Ted Cruz's amendment. Under the provision, insurers would be allowed to sell watered-down health insurance coverage as long as they also sell at least one plan that complies with the Obamacare regulations. The CBO has not yet evaluated what this kind of legislation would do to the health care market, but insurance companies have almost universally denounced the plan as unworkable.

Another plan some Republicans are considering is called "skinny repeal," which would simply strip out a few key provisions from Obamacare —most notably, the individual mandate. The mandate, which levies a tax on adults who do not purchase health insurance, is one of the least popular parts of the law, but economists say it is necessary to keep premiums from spiking.

Many of the provisions of BCRA and many of the amendments under consideration may violate the obscure Senate "Byrd Rule," meaning they would need 60 votes to pass. This would mean the bill in its entirety would have no chance of passing because it would need at least eight Democrats to support it along with every Republican.

New amendments could be tacked on to the House bill, but it's not clear what they would entail, and there's been no public debate or formal evaluation of such a move. Many Republican senators would likely be unwilling to vote for measures they haven't had much time to consider. It may be that all Senate Majority Leader Mitch McConnell wants is an on-the-record vote — regardless of outcome — to hold his party to account and show the Republican base that the Senate tried to finally repeal and replace Obamacare.

But it may be unwise to doubt Republican lawmakers' resolve. Despite universal pronouncements of its death, the American Health Care Act was successfully revived and passed through the House in May.

Watch: With The Clock Running, Senate Health Care Bill Has A Long Way To Go

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