Senate opens 'Obamacare' debate at last but outcome in doubt

WASHINGTON (AP) — Prodded by President Donald Trump, a bitterly divided Senate voted, at last, Tuesday to move forward with the Republicans' long-promised legislation to repeal and replace "Obamacare." There was high drama as Sen. John McCain returned to the Capitol for the first time after being diagnosed with brain cancer to cast a decisive "yes" vote.

The final tally was 51-50, with Vice President Mike Pence, exercising his constitutional prerogative, breaking the tie after two Republicans joined all 48 Democrats in voting "no."

When the Senate voted Tuesday evening on the bill's initial amendment, it underscored how hard it will be for the chamber's divided Republicans to pass a sweeping replacement of Obama's law.

By 57-43 — including nine GOP defectors — it blocked a wide-ranging proposal by Senate Majority Leader Mitch McConnell to erase and replace much of the statute. It included language by Sen. Ted Cruz, R-Texas, letting insurers sell cut-rate policies with skimpy coverage, plus an additional $100 billion to help states ease out-of-pocket costs for people losing Medicaid — a provision sought by Midwestern moderates including Rob Portman, R-Ohio.

On the day's opening vote to begin debate, and with all senators in their seats and protesters agitating outside and briefly inside the chamber, the vote was held open at length before McCain, 80, entered the chamber. Greeted by cheers, he smiled and dispensed hugs — but with the scars from recent surgery starkly visible on the left side of his face.

Despite voting "yes," he took a lecturing tone afterward and hardly saw success assured for the legislation after weeks of misfires, even after Tuesday's victory for Trump and Republican leader Mitch McConnell.

"If this process ends in failure, which seems likely, then let's return to regular order," McCain said as he chided Republican leaders for devising the legislation in secret along with the administration and "springing it on skeptical members."

"Stop listening to the bombastic loudmouths on the radio, TV and internet. To hell with them!" McCain said, raising his voice as he urged senators to reach for the comity of earlier times.

At the White House earlier, after senators voted to consider the bill, Trump wasted no time in declaring a win and slamming the Democrats anew.

"I'm very happy to announce that, with zero of the Democrats' votes, the motion to proceed on health care has just passed. And now we move forward toward truly great health care for the American people," Trump said. "This was a big step. I want to thank Senator John McCain — very brave man."

Trump continued to celebrate the vote at a rally in Youngstown, Ohio that doubled as a victory lap.

"We're now one step closer to liberating our citizens from this "Obamacare" nightmare and delivering great health care for the American people" he said.

At its most basic, the Republican legislation is aimed at undoing "Obamacare'''s unpopular mandates for most people to carry insurance and businesses to offer it. The GOP would repeal "Obamacare" taxes and unwind an expansion of the Medicaid program for the poor, the disabled and nursing home residents The result would be 20 million to 30 million people losing insurance over a decade, depending on the version of the bill.

The GOP legislation has polled abysmally, while "Obamacare" itself has grown steadily more popular. Yet most Republicans argue that failing to deliver on their promises to pass repeal-and-replace legislation would be worse than passing an unpopular bill, because it would expose the GOP as unable to govern despite controlling majorities in the House, Senate and White House.

Tuesday's vote amounted to a procedural hurdle for legislation whose final form is impossible to predict under the Senate's byzantine amendment process, which will unfold over the next several days.

Indeed senators had no clear idea of what they would ultimately be voting on, and in an indication of the uncertainty ahead, McConnell, R-Ky., said the Senate will "let the voting take us where it will." The expectation is that he will bring up a series of amendments.

Yet after seven years of empty promises, and weeks of hand-wringing and false starts on Capitol Hill, it was the Senate's first concrete step toward delivering on innumerable pledges to undo former President Barack Obama's law. It came after several near-death experiences for earlier versions of the legislation, and only after Trump summoned senators to the White House last week to order them to try again after McConnell had essentially conceded defeat.

"The people who sent us here expect us to begin this debate, to have the courage to tackle the tough issues," McConnell said ahead of the vote.

Democrats stood implacably opposed, and in an unusual maneuver they sat in their seats refusing to vote until it was clear Republicans would be able to reach the 50-vote margin needed to get them over the top with Pence's help.

"Turn back," Minority Leader Chuck Schumer of New York implored his GOP colleagues before the vote. "Turn back now, before it's too late and millions and millions and millions of Americans are hurt so badly."

Schumer's pleas fell on deaf ears, as several GOP senators who'd announced they would oppose moving forward with the legislation reversed themselves to vote "yes." Among them were Dean Heller of Nevada, the most vulnerable Republican senator in next year's midterm elections, Shelley Moore Capito of West Virginia and Ron Johnson of Wisconsin.

Johnson has recently accused McConnell of operating in bad faith on the bill, and stood in intense conversation with him on the Senate floor before finally becoming the 50th Republican senator to vote "yes," immediately following McCain.

Democratic campaign groups immediately announced they would be targeting Heller and others with ads. The two Republicans voting "no" were Susan Collins of Maine and Lisa Murkowski of Alaska.

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Associated Press writers Alan Fram, Andrew Taylor, Matthew Daly, Mary Clare Jalonick and Stephen Ohlemacher contributed.

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BREAKING: With Pence breaking tie, Senate votes to begin debating Republican bill scuttling Obama health law in win for Trump, GOP. — The Associated Press (@AP) July 25, 2017

*This is a breaking news update. The original story appears below.*

WASHINGTON (AP) — President Donald Trump urged Republicans to "step up to the plate" for Tuesday's crucial Senate vote on their bill eviscerating much of the Obama health care law. A cliff-hanger roll call was likely, with added drama from Sen. John McCain's return to the Capitol for his first vote since being diagnosed with brain cancer.

No stranger to heroic episodes, the Navy pilot who persevered through five years of captivity during the Vietnam War announced he'd be back in Washington for the critical roll call on beginning debate on the legislation. The 80-year-old had been at home in Arizona since he revealed last week that he's undergoing treatment for the disease, but a statement said he "looks forward" to returning for work on health care and other legislation.

As the initial vote approached, it remained unclear exactly which version of the legislation Senate Majority Leader Mitch McConnell, R-Ky., would put in play. Republicans expect McCain to support taking up the measure, and his mere presence could make it harder for wavering Republicans to cast a vote against even considering the bill.

Keeping pressure on GOP senators, McConnell noted that many "made commitments to our constituents to provide relief from this failed left-wing experiment. And now we have a real opportunity to keep those commitments." He added, "I hope everyone will seize the moment."

In one sign of progress, conservative Sen. Rand Paul, R-Ky., said he would support commencing debate. He said McConnell told him the Senate would debate Paul's proposal to scuttle much of Obama's law and give Congress two years to enact a replacement — an amendment that seemed certain to lose.

Sen. Dean Heller, R-Nev., who'd opposed an initial version of the GOP bill because of its Medicaid cuts, said he'd also support starting debate but would vote against the final package if it wasn't improved for his state.

Democrats uniformly oppose the effort to tear down President Barack Obama's signature legislative achievement. Republicans control the chamber 52-48, meaning they can afford to lose just two Republicans with McCain around and only one in his absence. Vice President Mike Pence would cast a tie-breaking vote.

Trump kept up the pressure on GOP lawmakers, tweeting that "After 7 years of talking, we will soon see whether or not Republicans are willing to step up to the plate!" He added: "ObamaCare is torturing the American People. The Democrats have fooled the people long enough. Repeal or Repeal & Replace! I have pen in hand."

McConnell's bill would abolish much of Obama's law, eliminating its tax penalties on people not buying policies, cutting Medicaid, eliminating its tax boosts on medical companies and providing less generous health care subsidies for consumers. But at least a dozen GOP senators have openly said they oppose or criticized the measure, which McConnell has revised as he's hunted Republican support.

While the first vote had long seemed headed toward defeat, Republicans began showing glimmers of optimism. Senators and aides said talks were continuing aimed at winning over enough Republicans to commence debate.

Besides allowing an early vote on Paul's repeal plan, moderates were seeking additional money for states that would be hurt by cuts in Medicaid, the health insurance program for the poor, the disabled and nursing home patients. Conservatives wanted a vote on a proposal by Ted Cruz, R-Texas, letting insurers offer bare-bones policies with low premiums, which would be illegal under Obama's law.

With leaders still struggling to line up enough votes to approve a wide-ranging overhaul of Obama's law, there was talk of eventually trying to pass a narrow bill — details still unclear — so House-Senate bargainers could craft a compromise. That, too, was encountering problems.

"This idea that we're going to vote on something just to get in conference and then figure it out later is nuts," Sen. Lindsey Graham, R-S.C., told reporters.

Should Tuesday's vote fail, it would be an unalloyed embarrassment for a party that finally gained control of the White House, Senate and House in January but still fell flat on its promise to uproot Obamacare. Republicans could try returning to the bill later this year if they somehow round up more support.

Should the initial motion win, that would prompt 20 hours of debate and countless amendments in a battle likely to last all week. And even then, the measure's ultimate fate still seemed iffy because of GOP divisions.

Obama's law was enacted in 2010 over unanimous Republican opposition. Since then, its expansion of Medicaid and creation of federal insurance marketplaces has produced 20 million fewer uninsured people. It's also provided protections that require insurers to provide robust coverage to all, cap consumers' annual and lifetime expenditures and ensure that people with serious medical conditions pay the same premiums as the healthy.

The law has been unpopular with GOP voters and the party has launched numerous attempts to dismantle the statute. All until this year were mere aspirations because Obama vetoed every major one that reached him.

Ever since 2010, Republicans have been largely united on scuttling the statute but divided over how to replace it.

Those divides sharpened with Trump willing to sign legislation and estimates by the nonpartisan Congressional Budget Office that several GOP bills would cause more than 20 million people to become uninsured by 2026. Polls showing growing popularity for Obama's law and abysmal approval ratings for the GOP effort haven't helped.

The House approved its health care bill in May after several setbacks. With the House planning to begin summer recess this weekend, Majority Leader Kevin McCarthy, R-Calif., said the chamber would return to "finish the job" by considering whatever the Senate might approve.

Moderate Sen. Susan Collins, R-Maine, has remained opposed to beginning debate on any option McConnell has revealed so far.

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Associated Press writers Erica Werner and Andrew Taylor contributed to this report.

Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.