With Vice President Mike Pence casting the tie-breaking vote, the U.S. Senate voted Tuesday to begin debate on a bill to overhaul Obamacare.
Only two Republicans — Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, both centrists — voted against the measure.
The 51-50 vote was simply procedural, allowing the Senate to begin debate on revisions of major provisions of Obamacare, the controversial health reform law that was the centerpiece of President Barack Obama’s domestic agenda.
It’s now up to lawmakers to begin the difficult process of negotiating an alternative to Obamacare.
The Senate voted Tuesday on whether to use as a template a health care bill that narrowly passed the House of Representatives in May. That House bill, which would make substantial cuts to Medicaid, the government-run insurance program for low-income Americans, is unpopular with many Americans and even President Donald Trump called it “mean.”
Majority Leader Mitch McConnell (R-Ky.) has said the Senate would make significant changes to the House bill. Since the Senate vote Tuesday was largely procedural, it does not make any changes to Obamacare. But it allows lawmakers to begin the process of potentially repealing and replacing Obamacare.
Because Republicans hold a narrow 52-48 majority in the Senate, Vice President Pence served as the tie-breaker. All 48 Democrats oppose the GOP overhaul plan.
Sen. John McCain (R-Ariz.), who was diagnosed with a brain tumor last week after undergoing surgery for a blood clot, made a dramatic return to the Senate floor to cast his vote in favor of the measure. The 80-year-old McCain has been home in Arizona since last week when he started treatment for a type of brain cancer called glioblastoma.
In the end, his vote proved pivotal.
As early as last week, McConnell could not muster enough votes to move legislation to the Senate floor.
After regrouping, the GOP leadership decided to vote on a “motion to proceed” on the health bill passed by the House of Representatives in May.
That bill provides a framework for negotiating new legislation and gives senators an opportunity to offer potentially dozens of amendments. If it passes the Senate, lawmakers from both chambers of Congress would go into conference to work through their differences.
Early Tuesday, Trump sent out tweets aimed at holding Republicans accountable for their seven-year pledge to end Obamacare, also known as the Affordable Care Act.
“Obamacare is torturing the American People,” Trump tweeted. Whether the Senate agrees to repeal Obamacare or repeal and replace it, he said, his pen is ready to sign it.
The president’s remarks do not seem to reflect public sentiment.
Overall, 61 percent of Americans hold an unfavorable view of the Senate plan to repeal and replace Obamacare, according to the latest Kaiser Family Foundation tracking poll.
At least a dozen GOP senators have said they oppose or are critical of McConnell’s proposed repeal-and-replace legislation. Conservatives like Rand Paul (R-Ky.) say it doesn’t go far enough to dismantle Obamacare. Meanwhile, moderate Republicans like Collins oppose the suggested steep cuts to Medicaid.
The nonpartisan Congressional Budget Office estimated last Thursday that the latest Republican health care bill would leave an additional 22 million Americans without insurance by 2026.
Meanwhile, leaders of four major health and consumer advocacy groups on Tuesday called on both chambers of Congress to seek a bipartisan health care solution.
“Right now — today — is the best time to begin a thoughtful bipartisan discussion about this,” Dr. David Barbe, president of the American Medical Association, told reporters during a media briefing.
Barbe joined leaders of the American Hospital Association, AARP and the American Heart Association in calling for lawmakers to drop current repeal efforts and join together in examining ways to reduce cost, expand coverage and improve Medicaid.
FreedomWorks President Adam Brandon, whose organization supports free markets, lower taxes and smaller government, called the Senate vote “a step forward” in the process to repeal Obamacare. “The 2015 repeal bill is what conservative activists were promised, and it’s what they expect,” he said in a statement.
Read the latest version of Senate health reform.