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The Senate narrowly voted on Tuesday to open debate on the Republican effort to overhaul healthcare, kicking off a furious voting process after tumultuous arguments within the GOP.
A procedural vote to begin debate on the House’s healthcare bill passed, 51-50, as Vice President Mike Pence cast the tiebreaking vote. It came amid the dramatic return of Sen. John McCain, who cast a crucial vote in favor of the legislation, a week after announcing he had brain cancer.
Even with this step, it is unclear whether Republicans will have the votes to eventually repeal and replace the Affordable Care Act, the healthcare law known as Obamacare.
Every Democrat voted against the motion on Tuesday, as well as Republican Sens. Susan Collins and Lisa Murkowski. GOP leadership could not have afforded another defection.
Several Republican members who were on the fence about the motion voted for the measure after significant pressure from Majority Leader Mitch McConnell and the White House. Sen. Ron Johnson came to the floor and talked privately with McConnell before finally casting a “yes” vote.
The Senate will now begin 20 hours of debate on the healthcare bill, equally divided between Democrats and Republicans.
To get enough Republican senators on board with the motion to proceed, McConnell most likely promised to bring to a vote multiple versions of amendments, including the Obamacare Repeal Reconciliation Act, which would repeal the law, and the Better Care Reconciliation Act, which would repeal and replace it.
GOP members say McConnell is most likely assuming both of those measures will fail and will then begin a so-called skinny repeal process – a series of amendments that would repeal certain parts of the ACA.
If those passed within the shell of the House bill, Republicans from both sides of Congress would come together in a conference committee to draft a compromise.
“I applaud the Senate for taking a giant step to end the Obamacare nightmare,” President Donald Trump said in a statement. “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 increases 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.”
Here’s a rundown of what could happen from here:
- Twenty hours of debate – in legislative time – will begin, split equally between Democrats and Republicans. The first amendment to be voted on is likely to be the ORRA to satisfy conservative holdout Rand Paul and other conservatives. This plan is likely to be shot down by moderates. The first amendment to be offered procedurally – but the second to be voted on, the news website Axios reported – would be the BCRA, which was last updated on Thursday. Again, Republicans can afford only two defections. According to reports, there is an agreement between Sen. Rob Portman, a more moderate holdout, and Sen. Ted Cruz, a conservative, on an amendment that would keep the structure of the BCRA but allow insurers to sell non-Obamacare-compliant policies and throw in $100 billion to the state stabilization fund. But since that would require 60 votes to pass, and it has not been scored by the Congressional Budget Office, it is almost certainly doomed, since there are only 52 Republicans in the Senate. There could then be a series of amendments to the House bill, including those from Democrats. Additionally, other healthcare legislation could be slotted in for a vote. Finally, McConnell will try to push the Senate to pass a bundle of smaller amendments focused on repealing aspects of the ACA, like the individual mandate and medical-device tax. After this, the House and the Senate would flesh out a full replacement bill in a conference committee.