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| Senate Republicans vote to open debate on repealing and replacing Obamacare | Senate Republicans vote to open debate on repealing and replacing Obamacare |
| (35 minutes later) | |
| Senate Republicans took a tentative step toward fulfilling seven years of promises to repeal the Affordable Care Act (ACA) on Tuesday, something they achieved only after the dramatic return of Senator John McCain, who was diagnosed last week with brain cancer. | Senate Republicans took a tentative step toward fulfilling seven years of promises to repeal the Affordable Care Act (ACA) on Tuesday, something they achieved only after the dramatic return of Senator John McCain, who was diagnosed last week with brain cancer. |
| The procedural vote, which passed without the support of a single Democrat, allows the Senate to open debate on repealing and replacing the ACA, popularly known as Obamacare, even though it remains unclear exactly what legislation they will be voting on. | The procedural vote, which passed without the support of a single Democrat, allows the Senate to open debate on repealing and replacing the ACA, popularly known as Obamacare, even though it remains unclear exactly what legislation they will be voting on. |
| Fifty Republicans voted yes and two – Susan Collins of Maine and Lisa Murkowski of Alaska – voted no. Vice-president Mike Pence’s tie-breaking vote was required to pass the measure. | Fifty Republicans voted yes and two – Susan Collins of Maine and Lisa Murkowski of Alaska – voted no. Vice-president Mike Pence’s tie-breaking vote was required to pass the measure. |
| The fact that a vote simply to open debate was seen as a victory for the Republicans is a measure of how difficult the GOP has found it to overhaul Barack Obama’s healthcare law, which extended health insurance to nearly 20 million more people. | The fact that a vote simply to open debate was seen as a victory for the Republicans is a measure of how difficult the GOP has found it to overhaul Barack Obama’s healthcare law, which extended health insurance to nearly 20 million more people. |
| Donald Trump praised the Senate for what he characterized as “a giant step to end the Obamacare nightmare”. | Donald Trump praised the Senate for what he characterized as “a giant step to end the Obamacare nightmare”. |
| “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 president said in a statement shortly after the vote. | “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 president said in a statement shortly after the vote. |
| “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.” | “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.” |
| Of the two dissenting Republicans, Trump called their votes “very, very sad ... for them”. | Of the two dissenting Republicans, Trump called their votes “very, very sad ... for them”. |
| After months of discussion, debate and negotiations, Senate Republicans will now probably be forced to choose between a number of unpalatable options, including: a discarded and possibly untenable plan to replace the 2010 healthcare law; a measure that repeals it without implementing a replacement; and a so-called “skinny repeal” which would eliminate certain pieces of the law, including the requirement that all Americans have healthcare coverage or face a penalty. | After months of discussion, debate and negotiations, Senate Republicans will now probably be forced to choose between a number of unpalatable options, including: a discarded and possibly untenable plan to replace the 2010 healthcare law; a measure that repeals it without implementing a replacement; and a so-called “skinny repeal” which would eliminate certain pieces of the law, including the requirement that all Americans have healthcare coverage or face a penalty. |
| None of the plans appeared to have enough support to pass despite senators voting to open debate on Tuesday. | None of the plans appeared to have enough support to pass despite senators voting to open debate on Tuesday. |
| A motion to proceed opens a chaotic process during which the Senate can consider numerous amendments to the bill, including complete replacements. During the process, senators will be forced to cast a number of contentious votes that could haunt those facing tough re-election battles. | A motion to proceed opens a chaotic process during which the Senate can consider numerous amendments to the bill, including complete replacements. During the process, senators will be forced to cast a number of contentious votes that could haunt those facing tough re-election battles. |
| Mitch McConnell, the Senate majority leader, called the vote a “first step” and said he expected Republicans to pass a repeal bill – though he couldn’t say which – by the end of the week. | Mitch McConnell, the Senate majority leader, called the vote a “first step” and said he expected Republicans to pass a repeal bill – though he couldn’t say which – by the end of the week. |
| “It’s just the beginning. We’re not out here to spike the football,” McConnell said. “This is a long way but we’ll finish at the end of the week hopefully with a measure that can either go to the House and be taken up or go to conference.” | “It’s just the beginning. We’re not out here to spike the football,” McConnell said. “This is a long way but we’ll finish at the end of the week hopefully with a measure that can either go to the House and be taken up or go to conference.” |
| After the vote, Democrats joined protesters outside the Capitol, striking a defiant tone and urging the activists to keep the pressure on wavering Republicans. | After the vote, Democrats joined protesters outside the Capitol, striking a defiant tone and urging the activists to keep the pressure on wavering Republicans. |
| “We are in the fight of our lives,” Ron Wyden, a Democrat of Oregon, said, rallying the protesters. | “We are in the fight of our lives,” Ron Wyden, a Democrat of Oregon, said, rallying the protesters. |
| As McConnell called for the vote to begin, protesters inside the Senate gallery began shouting, “Kill the bill! Kill the bill!” followed by chants of “Shame!” as security escorted them outside the chamber. | As McConnell called for the vote to begin, protesters inside the Senate gallery began shouting, “Kill the bill! Kill the bill!” followed by chants of “Shame!” as security escorted them outside the chamber. |
| Speaking on the Senate floor, McConnell framed the healthcare debate as the opportunity Republicans had been awaiting for years. | Speaking on the Senate floor, McConnell framed the healthcare debate as the opportunity Republicans had been awaiting for years. |
| “They didn’t send us here just to do the easy stuff,” the majority leader said of the voters who put Republicans in charge of Congress. “They sent us to tackle the big problems. | “They didn’t send us here just to do the easy stuff,” the majority leader said of the voters who put Republicans in charge of Congress. “They sent us to tackle the big problems. |
| “With a surprise election comes great opportunities to do things we thought were never possible.” | “With a surprise election comes great opportunities to do things we thought were never possible.” |
| McCain returned to the Senate, with his wife Cindy by his side, to a loud round of applause from lawmakers. The Arizona senator voted in favor of the motion to proceed, consistent with his prior statements on the issue. | McCain returned to the Senate, with his wife Cindy by his side, to a loud round of applause from lawmakers. The Arizona senator voted in favor of the motion to proceed, consistent with his prior statements on the issue. |
| Several key holdouts caved in the final moments leading up to the vote in a dramatic reversal from their previous reservations about the Republican strategy. | Several key holdouts caved in the final moments leading up to the vote in a dramatic reversal from their previous reservations about the Republican strategy. |
| Senator Dean Heller, who is facing a tough re-election battle in Nevada in 2018, was among the most stunning turnarounds. Just last month, the Republican publicly lambasted the proposal put forth by party leadership and said it was a “lie” that the plan would lower premiums. Heller said he still had concerns about the legislation proposed thus far and would only support a final product if it addressed his needs, such as protecting the Medicaid program. | Senator Dean Heller, who is facing a tough re-election battle in Nevada in 2018, was among the most stunning turnarounds. Just last month, the Republican publicly lambasted the proposal put forth by party leadership and said it was a “lie” that the plan would lower premiums. Heller said he still had concerns about the legislation proposed thus far and would only support a final product if it addressed his needs, such as protecting the Medicaid program. |
| “If the final product isn’t improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it,” Heller said. | “If the final product isn’t improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it,” Heller said. |
| Similar statements came from other Senate Republicans who had previously opposed the party’s direction on healthcare. Senators Shelley Moore Capito of West Virginia, Rob Portman of Ohio, Jerry Moran of Kansas and Mike Lee of Utah all cast votes in favor of advancing to a debate, while expressing their hope that negotiations would lead to a better outcome. | Similar statements came from other Senate Republicans who had previously opposed the party’s direction on healthcare. Senators Shelley Moore Capito of West Virginia, Rob Portman of Ohio, Jerry Moran of Kansas and Mike Lee of Utah all cast votes in favor of advancing to a debate, while expressing their hope that negotiations would lead to a better outcome. |
| The Wisconsin senator Ron Johnson, another swing vote, was among the last to vote for moving forward. Johnson, who has publicly criticized McConnell in recent weeks, could be seen having a lengthy exchange with the majority leader on the Senate floor. Although he bristled in speaking to reporters in the hallway about the process, the senator nonetheless fell in line with the rest of his party. | The Wisconsin senator Ron Johnson, another swing vote, was among the last to vote for moving forward. Johnson, who has publicly criticized McConnell in recent weeks, could be seen having a lengthy exchange with the majority leader on the Senate floor. Although he bristled in speaking to reporters in the hallway about the process, the senator nonetheless fell in line with the rest of his party. |
| Republicans, including the president, appeared to treat the motion to proceed as if it were the vote to repeal, pushing senators to open debate and let the rest fall into place later. Democrats will almost certainly portray a vote by their opponents to advance the bill as a vote in favor of the legislation, irrespective of whether a vote on repealing and/or replacing Obama’s healthcare law ultimately succeeds. | Republicans, including the president, appeared to treat the motion to proceed as if it were the vote to repeal, pushing senators to open debate and let the rest fall into place later. Democrats will almost certainly portray a vote by their opponents to advance the bill as a vote in favor of the legislation, irrespective of whether a vote on repealing and/or replacing Obama’s healthcare law ultimately succeeds. |
| Complicating the vote are a pair of analyses by the nonpartisan Congressional Budget Office (CBO). One estimate found that the latest draft of the Republican bill would leave 22 million more people uninsured, compared to current law, by 2026. If Republicans choose to repeal major provisions of the law without immediately replacing it, the CBO estimates that 32 million people will lose out in the same time period. | Complicating the vote are a pair of analyses by the nonpartisan Congressional Budget Office (CBO). One estimate found that the latest draft of the Republican bill would leave 22 million more people uninsured, compared to current law, by 2026. If Republicans choose to repeal major provisions of the law without immediately replacing it, the CBO estimates that 32 million people will lose out in the same time period. |
| Activists and constituents have pleaded with lawmakers not to repeal the ACA, inundating their office telephone lines and confronting them at town halls. Liberal groups have also ratcheted up the pressure with rallies, protests and acts of civil disobedience. | Activists and constituents have pleaded with lawmakers not to repeal the ACA, inundating their office telephone lines and confronting them at town halls. Liberal groups have also ratcheted up the pressure with rallies, protests and acts of civil disobedience. |
| Republicans are meanwhile contending with a marked shift among voters over the law and the role government should play in ensuring healthcare coverage. Opinion polls show growing support for the ACA, compared with dismal approval ratings for the replacement plan. | Republicans are meanwhile contending with a marked shift among voters over the law and the role government should play in ensuring healthcare coverage. Opinion polls show growing support for the ACA, compared with dismal approval ratings for the replacement plan. |
| But after years of promising to repeal the ACA, a popular position that helped fuel the rise of small-government conservatives, Republicans face a growing consensus that the government has a responsibility to guarantee healthcare. A survey by the Pew research center found that 60% of Americans believe the federal government should be responsible for ensuring healthcare coverage, compared with 38% who say it should not be the government’s responsibility. The share of people with this view grew from 51% last year and now stands at its highest point in nearly a decade, according to Pew. | But after years of promising to repeal the ACA, a popular position that helped fuel the rise of small-government conservatives, Republicans face a growing consensus that the government has a responsibility to guarantee healthcare. A survey by the Pew research center found that 60% of Americans believe the federal government should be responsible for ensuring healthcare coverage, compared with 38% who say it should not be the government’s responsibility. The share of people with this view grew from 51% last year and now stands at its highest point in nearly a decade, according to Pew. |
| Nearly 20 million people gained healthcare coverage under Obama’s Affordable Care Act. The law requires all Americans to have insurance or face a penalty and offered states funding incentives to expand Medicaid coverage for people with low incomes. | |
| Nearly 74 million people receive coverage through Medicaid, the joint federal- and state-funded insurance program for low-income people, and its sister program Chip, which covers low-income children. | |
| Despite voting to begin debate, moderate Republicans said their concerns remained over steep cuts to Medicaid under the proposals laid out by party leaders. It was not immediately clear what would come next, with a lack of consensus on how to replace the healthcare law still preventing the party from coalescing around a bill. | Despite voting to begin debate, moderate Republicans said their concerns remained over steep cuts to Medicaid under the proposals laid out by party leaders. It was not immediately clear what would come next, with a lack of consensus on how to replace the healthcare law still preventing the party from coalescing around a bill. |
| In an impassioned floor speech after the vote, McCain urged his colleagues to return to regular order and hold hearings. He criticized the process thus far as occurring behind closed doors. | |
| Although he voted to advance the measure to a debate, McCain declared: “I will not vote for this bill as it is today.” | |
| The president thanked McCain for travelling to Washington despite his condition. “Very brave man,” he told reporters in the White House rose garden. “He made a tough trip to get here and vote.” | |
| It would take just three GOP senators to kill a final bill, should Republicans come up with a revised replacement plan. | It would take just three GOP senators to kill a final bill, should Republicans come up with a revised replacement plan. |
| “Healthcare is always difficult because you have to weed a very, very narrow path, like a quarter of an inch wide, right down the middle,” said Trump. “If you go a little bit too far right, you lose three people on the left, and if you go a little bit too far left, you lose five people on the right. | |
| “It is a very complex and difficult task, but it’s something I actually know quite a bit about ... This is the beginning of the end for the disaster known as Obamacare.” | |
| Andy Roth, a vice-president at the conservative Club for Growth, celebrated the vote as an opportunity to put Republicans on the record about dismantling Obamacare. | |
| “It’s very important that senators are now going to be held accountable,” he told the Guardian. “That’s been our biggest frustration so far, that a lot of moderate Republicans have been hiding from actually voting on repeal. And now we’re going to find out.” | “It’s very important that senators are now going to be held accountable,” he told the Guardian. “That’s been our biggest frustration so far, that a lot of moderate Republicans have been hiding from actually voting on repeal. And now we’re going to find out.” |
| Additional reporting by Ben Jacobs in Washington | Additional reporting by Ben Jacobs in Washington |