Nail-Biter: Obamacare Repeal Stays Alive for Now

Senate GOP leaders win close vote to open debate — but path to health care victory remains elusive

by Brendan Kirby | Updated 26 Jul 2017 at 6:22 AM

The Obamacare repeal lives to fight another day.

After weeks of wrangling, the Senate voted narrowly Tuesday in favor of a procedural move to start debate on a proposal to repeal the Affordable Care Act.

Sen. John McCain (R-Ariz.), fresh off a cancer diagnosis, came back to Washington to help put the “yes” votes over the top. He entered the chamber to applause and cast the 50th “yes” vote, allowing Vice President Mike Pence to break the tie.

Sens. Dean Heller (R-Nev.), Shelley Moore Capito (R-W.Va.), Rob Portman (R-Ohio) and Jerry Moran (R-Kan.) — all of whom either had been "no" votes or had expressed serious concerns — ended up giving Senate Majority Leader Mitch McConnell (R-Ky.) the votes he needed.

Of Republicans, only Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, opposed the measure.

Speaking at a news conference shortly after the vote, President Donald Trump praised the result, which he said would deliver "truly great health care" to the American people.

"This was a great first step," he said.

Hours before the vote, McConnell said on the Senate floor that a "yes" vote was merely a vote to start the process. He said not doing so would amount to a repudiation of promises GOP senators had made for years.

"Many of us have made commitments to our constituents to provide relief from this failed left-wing experiment," he said. "And now we have a real opportunity to keep those commitments by voting to begin debate and ultimately to send smarter health care solutions to the president's desk for his signature."

McConnell said average premiums have doubled for people who buy insurance through the government-run online exchanges set up by the Affordable Care Act. What's more, he said, people find themselves with dwindling choices as insurance companies flee the market.

As hard as getting to "yes" was, it likely represents the easy part. McConnell tried and failed to build consensus around a replacement for the Affordable Care Act. He could not come up with a plan that could keep both moderates and conservatives on board. So he opted for a vote on the repeal bill passed by the House of Representatives, kicking off an open-ended process that will allow any senator to offer amendments during the debate.

Any one of a long list of controversial amendments, if passed, could kill the whole effort. And then, even if the Senate manages to pass an actual bill, it would set up a conference committee of senators and representatives to negotiate a single compromise bill.

"Our health care insurance system is a mess. We all know it — those who support Obamacare and those who oppose it. Something has to be done."

Then both houses would have to vote again in favor of that legislation.

In a sign of how difficult that will be, McCain said he would not vote for it without substantial changes. He lamented the closed-door process that has dominated attempts to overhaul the health system. He said the Senate has become "more tribal" and is not getting anything done for the American people.

"Our health care insurance system is a mess. We all know it — those who support Obamacare and those who oppose it. Something has to be done," he said. "We Republicans have looked for a way to end it and replace it with something else without paying a terrible political price. We haven't found it yet, and I'm not sure that we ever will. All we've managed to do is make more popular a policy that wasn't very popular when we started trying to get rid of it."

Before the vote, Senate Minority Leader Chuck Schumer blasted Republicans and warned of all manner of horrors that would result from a vote to start debate.

"Don't be fooled by this ruse. A vote in favor of the motion to proceed will mean deep cuts to Medicaid, maybe even deeper than in the House bill," he said. "It will mean people with pre-existing conditions will be left high and dry. It will mean huge tax breaks for the wealthiest of Americans. It will mean millions will lose their coverage."

Schumer said McConnell's strategy is to get anything to the conference committee and then build pressure to vote for final passage.

Josh Blackman, author of "Unraveled: Obamacare, Religious Liberty, and Executive Power," suggested that Schumer might be right. Senators caught between the their own campaign promises and disagreements over the specifics of a repeal, might feel the best course of action is to pass a bill and then go on recess before having to make a hard decision on the final version.

Can it be done?

"I'll answer that question with an observation," said Blackman, a law professor at South Texas College of Law Houston. "I didn't think this was going to pass."

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