WASHINGTON (CN) – The Republican-run Senate on Wednesday afternoon rejected a GOP proposal to repeal major parts of the Affordable Care Act without providing a replacement.

Seven Republicans joined all Democrats Wednesday in a 45-55 vote an amendment by Rand Paul of Kentucky that would have repealed most of former President Obama’s health care law, with a two-year delay but no replacement.

The plan would have defunded Planned Parenthood and also included a provision that would have prevented people from claiming a tax credit on plans that cover most abortions.

The vote came less than a day after nine Republicans joined every Democrat in opposing a procedural objection against a modified version of a plan to repeal and replace the Affordable Care Act, which is more commonly known as Obamacare.

Republican Sens. Lamar Alexander, Shelley Moore Capito, Susan Collins, Dean Heller, John McCain, Lisa Murkowski and Rob Portman all voted against the measure, with Alexander being a somewhat surprising addition to the bloc opposing the repeal-only legislation.

In 2015, Alexander voted for a nearly identical measure that former President Barack Obama vetoed, but said the timing of the vote is different now.

“I agree with President Trump who said when we repeal Obamacare we ought to replace it at the same time,” Alexander told reporters. “In 2015 we might have been able to wait two years, but not now.”

Democrats did not bring a procedural objection to the amendment as they were expected to. The objection, similar to the one that killed the Republican replacement plan last night, would have claimed the amendment violated budgetary rules specific to the reconciliation process, the special measure that Republicans are using to pass their health care legislation.

The most likely outcome after the two recent failures seems to be for Republicans to move to a “skinny repeal” bill, which would eliminate Obamacare’s individual and employer mandates as well as a tax on medical devices but leave the rest of the law in place.

Alexander told reporters that plan, a previous version of which the CBO said would leave 15 million more people without insurance than under current law, would be the best way to get the bill to a conference committee where lawmakers could iron out differences between the House version of the bill and whatever law the Senate passes.

“There best opportunity for a strong signal of stability is for us to succeed in the Senate, agree with the House and pass a legislation that addresses the Affordable Care Act problems this month,” Alexander told reporters.

Capito, R-W.Va., said she could not commit to voting for the skinny repeal plan without being able to see the text, which has not yet been released.</s>Senate Republicans narrowly cleared their first hurdle toward repealing Obamacare. What comes next is complicated and unpredictable. At the end, it’s not clear anything will pass.

Senators will start with pretty meaty proposals H.R. 1628 (115) to take the guts out of Obamacare — but after debate, amendments, more debate, the parliamentarian’s rulings, budget points of order and a “vote-a-rama” — it’s highly uncertain whether the GOP will have 50 votes to pass even a “skinny” backup piece of legislation.

“All we have to do today is to have the courage to begin the debate with an open amendment process,” Senate Majority Leader Mitch McConnell said Tuesday, urging Republicans to let the debate begin. “And let the voting take us where it will.”

Here’s what to watch for.

The Senate had to shelve its repeal-replace package because it didn’t have 50 votes — partly because the nonpartisan Congressional Budget Office projected that it would lead to 22 million fewer Americans having health insurance coverage in a decade. That’s partly because of changes to Obamacare — and partly because of sweeping changes to federal financing of Medicaid, a low-income health care program that predated Obamacare by decades.

The bill still doesn’t have the votes — but it is serving as a starting point and lets senators dispatch with various big amendments. For instance, Sen. Ted Cruz’s (R-Texas) amendment, which would let insurers sell skimpy health plans as long as they also sell Obamacare-compliant ones, will get knocked out on a budget point of order, since it was never scored by the CBO. Critics of Cruz’s provision, including some in his own party, say it would send premiums sky high for people who are older and sicker, and lead the insurance market into a “death spiral.”

Another big amendment, likely to also get killed on a point of order, is Sen. Rob Portman’s (R-Ohio) proposal to add $100 billion to help people who are now covered under Obamacare’s Medicaid expansion shift into the private insurance market.

The Senate would then move to a straight repeal bill. It’s very similar to the one that the chamber passed in 2015 that then-President Barack Obama vetoed. That’s almost certain to fail too. One big reason: CBO projected it would lead to more than 30 million fewer Americans with coverage. It was easy for Republicans to vote for the measure when they knew that Obama would veto it. Now there are consequences.

Allowing a vote on straight repeal was necessary in order to get legislation to the floor. Conservative hardliners like Sens. Rand Paul (R-Ky.) and Mike Lee (R-Utah) can then tell voters they followed through on campaign promises to dismantle the Affordable Care Act.

It will also give conservative advocacy groups, which are still crusading for repeal, a chance to hold senators who fail to back the bill accountable. They’re likely to seek primary challengers to some of the senators who fail to back straight repeal. They’ve already begun attacking Sens. Lisa Murkowski (R-Alaska) and Shelley Moore Capito (R-W.Va.) as hypocrites for failing to follow through on campaign promises.

Once the Senate burns through its 20 hours of debate, split among Republicans and Democrats, it goes to a vote-a-rama, which at this point looks like it will be late Thursday. Theoretically that allows for unlimited amendments as long as they are relevant. But probably a few dozen will be voted on.

Here’s where Democrats get to offer a laundry list of ideas and force Republicans to take tricky votes. That could include efforts to stabilize the Obamacare markets, such as seeking funding for cost-sharing subsidies that the Trump administration has threatened to eliminate — potentially making the markets implode.

Senate Republicans also face major procedural hurdles in moving forward with legislation. The parliamentarian has determined that several key provisions of their repeal plan — including eliminating funding for Planned Parenthood for one year and banning coverage of abortion in Obamacare insurance plans — don’t meet the strict budget reconciliation rules required to pass legislation with just a majority of votes, and no filibusters.

To keep any provisions flagged by the parliamentarian as a no-go, the GOP would need to get 60 votes. And that’s a nonstarter with every Democrat opposed. Republicans will try and amend the language of the some of the offending provisions so that they pass muster with the parliamentarian. A bill without Planned Parenthood or abortion language creates another set of hurdles for Republican leaders to keep conservative support.

The biggest sticking point for Republicans, particularly in the Senate, has been how to deal with Obamacare’s Medicaid expansion. Senators from states that adopted expansion, such as Ohio and West Virginia, are deeply troubled by the prospect of taking away coverage from low-income people. That’s exacerbated by concerns about the opioid crisis roiling the country, and whether people who are now on Medicaid would no longer have access to treatment.

The Senate’s repeal package cut nearly $800 billion from the program over a decade — and not just from expansion. It also overhauls the funding formula so that federal payments would be capped for each beneficiary.

When all else fails, McConnell will probably offer senators a “skinny” repeal bill. It could change over the next few days, but the plan right now is simply to scrap the individual and employer mandates and the medical device tax.

Basically no senators will like it — but they may vote for it just to keep the repeal drive going. Passing a skinny bill would enable the Senate to negotiate with the House on a compromise package that can clear both chambers. But it’s not clear that even that stripped-down package can garner the 50 votes from Republicans needed to pass.

Nor is it clear that a deal can be struck with the House, which voted for a far more sweeping repeal and replace package, including the Medicaid changes and state waivers that could wipe out Obamacare patient protections for people with health conditions.

President Donald Trump’s messaging on health care has been a mess. He’s cheered the prospect of the collapse of the Obamacare — and called the House bill “mean.” But he’s hungry for a legislative win. If a repeal bill lands on his desk — fat, skinny, or in between — chances are he’ll sign it.</s>(CNN) With Republicans controlling both houses of Congress and President Donald Trump eager to repeal, their chance to fulfill their campaign promise to jettison Obamacare has arrived.

But it hasn't been so simple, given the differing priorities among the 52 Senate Republicans. Moderates want to make sure that people back home wouldn't be hurt by a repeal bill while conservatives want more regulations repealed

Here's how the Senate debate will go down -- and what you may have missed:

* The Senate reconvened at 10 a.m. ET. There are roughly 10 hours on the debate clock.

* The first amendment vote scheduled is for shortly after 2 p.m. ET -- a "Medicare for All" bill. This is a Republican amendment but it's really a record to get Democrats on the record for or against a "single payer" health care plan. GOP senators will oppose it.

* Once the debate clock runs out, or either or both sides yield back their time, that is when the vote-a-rama starts -- sometime after dinner, most likely.

* When will it end? When senators from both sides run out of amendments. It's like baseball: there's no clock.

* What's the final bill? The leading (and perhaps only) option at this point is a pared back repeal plan (known on the Hill as "skinny" repeal .) This proposal isn't public yet and is still being drafted, but the idea is to limit the final measure to only a few items at least 50 senators can agree on. The idea being pitched by leaders is to pass it, then move into a conference negotiation between the House and the Senate. There they'd hammer out a compromise that can again pass both sides of Congress and reach President Donald Trump's desk for his signature.

* Can that get the 50 votes needed to pass? Stay tuned.

How the Senate has voted this week

1. YES to proceed to floor debate

3. NO to a repeal-only measure, with a two-year delay

What is the "skinny repeal?"

The so-called "skinny repeal" of Obamacare would start with a repeal of only the individual and employer mandates as well as the medical device tax. It may expand in the hours ahead as Senate leaders try and corral the necessary votes, but that's the bare bones version of what's on the table.

The individual mandate requires nearly all Americans to obtain health insurance or pay a penalty, and the employer mandate requires larger companies to provide affordable coverage to their full-time workers.

Experts have already warned the skinny repeal could drive up the cost of insurance and destabilize the individual insurance market. But the ultimate goal Thursday is to get to a conference committee.</s>On the same day that the United States Senate cast a crucial procedural vote that could lead to abolishing the nation’s health care law, the Affordable Care Act, Donald Trump will hold a campaign rally that will live stream from the Trump stronghold of Youngstown, Ohio, on Tuesday. A live stream of the Trump speech, coming just a day after Trump delivered a controversial speech to the Boy Scouts of America, may be viewed by scrolling down on this page.

The Trump campaign rally is scheduled to get underway at 7 p.m. Eastern Daylight Time, 4 p.m. Pacific, at Covelli Centre in Youngstown, about four hours after the Senate cast a razor-close vote to proceed with debate on whether or not to repeal the Affordable Care Act, better known as “Obamacare;” the signature legislation passed during the term of President Barack Obama.

An actual vote on whether to repeal “Obamacare” will likely take place later this week. On Tuesday, the Senate split 50 votes to 50 on the move to proceed with debate on repeal. All 46 Senate Democrats plus the Senate’s two independents — Bernie Sanders of Vermont and Angus King of Maine — voted against moving ahead with the repeal debate. Two Republicans also voted “no,” breaking ranks with their party and with Trump, who has demanded that Republicans show “loyalty” to him by voting in favor of repealing the Affordable Care Act.

Watch a live stream of Trump’s Youngstown rally celebrating the Senate vote by clicking on the video below, courtesy of Right Side Broadcasting.

Republican Senators Susan Collins of Maine and Lisa Murkowski of Alaska were the two GOP members joining Democrats in the “no” vote. In cases of a tie vote in the Senate, the vice president is called upon to cast a tie-breaking vote, which Mike Pence did, giving the “no” vote a 51-50 majority win.

Youngstown is considered a bellwether of how white working class voters will tilt in presidential elections, and Trump visited the city — with its small population of only 60,000 residents — three times during his 2016 presidential campaign. Youngstown voters supported Trump in that election, and polls show that support for Trump in the Youngstown region remains strong.

Nonetheless, those same voters worry about how Trump’s effort to repeal the Affordable Care Act will affect their lives and their own health care. In interviews with the Associated Press, area residents expressed mixed opinions about Trump and his health care repeal push.

Jeni and Kevin Potter, whose 13-year-old daughter Erin is a three-time leukemia victim, told the AP that they might be forced to move to Canada — which has a national health insurance program — or the state of Massachusetts, which has its own state-level health care program similar to “Obamacare,” if the health care repeal strongly backed by Trump passes and is signed into law.

By contrast, 72-year-old Judy Martin told the AP that even though she has spent her entire life savings after working 51 years in a factory on medical expenses and now spends $400 of her $1,500 monthly Social Security benefit on medications and other health care costs, she believes that Trump will lower her medical expenses “and that he will take care of the little people.”</s>WASHINGTON (CBSMiami) – Senators will be back on Capitol Hill on Wednesday to continue debate on repealing and replacing the Affordable Care Act, aka Obamacare.

Tuesday night, by a vote of 43-57 the Senate Republican plan to repeal and replace the health care law failed on a procedural vote.

The Senate adjourned but will return at 9:30 a.m. to resume debate and consideration of amendments to a Republican health care bill. The next series of votes is expected at 11:30 a.m.

The vote on that bill took place just hours after they decided, by the narrowest margin possible, to proceed with debates on health care.

“We’re now one step closer to liberating our citizens from this Obamacare nightmare,” said President Donald Trump during a press conference Tuesday afternoon.

Wednesday’s debate will focus on the American Health Care Act (AHCA), the GOP plan that passed the House of Representatives in May.

Numerous amendments will now be offered that will dramatically change the nature of the House-passed legislation. Some amendments include a proposal to repeal and replace Obamacare, while another could simply repeal the 2010 health care law in its entirety and provide Congress with two years to figure out a replacement health care plan.

Nine Republicans came out against Tuesday night’s amendment in the first of what is expected to be many versions of the bill headed to the Senate floor this week.

“Anyone who thinks this is over is sadly mistaken, there are many many Republicans who don’t like this bill who don’t want to vote for it, they’re under enormous pressure to vote for it,” said Sen. Chuck Schumer, D-NY.

The House plan, which was rejected by the Senate, is the one that, according to the nonpartisan Congressional Budget Office, would’ve resulted in 22 million fewer people with health care coverage by 2026.</s>WASHINGTON - The Senate voted Wednesday to defeat a bill that would have repealed Obamacare within two years without any immediate plan to replace the sweeping health care law.

Senators voted 45-55 in favor of the bill, falling six votes short of the 51 needed to pass it. Seven Republicans voted against it: John McCain of Arizona, Dean Heller of Nevada, Susan Collins of Maine, Rob Portman of Ohio, Lamar Alexander of Tennessee, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia.

The vote comes on the second day of a 20-hour Senate debate on health care as Republican leaders scramble to win enough votes from their own members to pass something to replace the Affordable Care Act. The Senate began its session Wednesday morning with about 17 hours left in the debate.

Here's a look at where things stand now:

What are they voting on today?

The big vote so far was the failed attempt to pass the amendment by Sen. Rand Paul, R-Ky., to repeal the Affordable Care Act within two years, which would have given lawmakers time to come up with a replacement plan before the law expired. The proposal is the same as one passed by Congress in 2015, which was vetoed by former president Barack Obama. Collins is the only Republican senator who voted against the bill both times.

With a Republican president in the White House, GOP leaders tried again. Paul and other conservatives have led the push for a complete repeal of Obamacare. But there has been a lot of hesitation among Republicans for "repeal" without a plan for "replace."

What have they already voted on?

On Tuesday, senators voted 50-50 to begin debate on a health care bill. Vice President Pence had to come to the Senate chamber to break the tie and allow debate to start.

After that, the biggest news came Tuesday night when senators defeated a Republican bill, on a vote of 43-57, to replace Obamacare. Nine Republican senators voted against the legislation, which was drafted by Senate Republican leaders.

It included a proposal by Sen. Ted Cruz, R-Texas, to allow insurers to sell bare-bones health care plans that don't cover maternity care and other major benefits as long as the companies also sell plans that include a full range of benefits.

The defeated plan also included a proposal by Sen. Rob Portman, R-Ohio, to provide $100 billion in aid to help low-income Americans pay their medical bills after they lose Medicaid coverage as a result of the Senate health care bill.

What are Democrats doing?

The Democrats have been voting against the Republican bills to repeal and replace Obamacare. They also are using procedural tactics to try to slow down the debate process.

For example, Sen. Joe Donnelly, D-Ind., will offer a motion Wednesday to send health care legislation back to the Finance Committee for consideration. On Tuesday, they objected to the usual Senate practice of waiving the reading of the bill, so Senate clerks had to spend several hours reading the leadership replacement bill aloud.

What happens after the 20 hours of debate are over?

A vote-a-rama will begin on dozens of amendments offered by senators of both parties. That is expected to start Thursday.

Do Republican Senate leaders have an endgame?

With the defeat of the comprehensive replacement bill and the "clean" repeal bill, GOP leaders are now looking to pass a "skinny repeal" bill that would make limited changes to Obamacare. It would likely strip out the law's tax on medical devices and its requirements for individuals to buy health insurance and large employers to provide coverage for their workers.

If that plan passes the Senate, it would most likely go to a conference committee of House and Senate negotiators who would try to work out a final compromise.

Democrats say Senate leaders just want to pass anything they can take to this conference committee, where the real bill would be crafted.

"It's becoming clearer that, in the end, the majority leader might push a much scaled-back version of repeal in the hopes of passing something, so-called skinny repeal, just to get to conference," Minority Leader Chuck Schumer, D-N.Y., said in a speech on the Senate floor Wednesday. "But my colleagues, make no mistake about it, skinny repeal is equal to full repeal. It's a Trojan horse designed to get the House and Senate into conference where the hard-right flank of the Republican Caucus, the (House) Freedom Caucus, will demand full repeal or something very close to it."

Why has it been so difficult for the Senate to reach agreement?

Republican leaders have been trying to please the conservative and moderate wings of their party, and they have so far failed to win the support of both groups.

Conservatives generally want a complete repeal of Obamacare's taxes and regulations while moderates worry that ending the law's Medicaid expansion will leave struggling Americans with no way to afford medical coverage.

"Ultimately, we want to get legislation to finally end the failed Obamacare status quo through Congress and to the president’s desk for his signature," Majority Leader Mitch McConnell, R-Ky., said Wednesday in a speech on the Senate floor. "This certainly won’t be easy. Hardly anything in this process has been."</s>WASHINGTON, D.C. (CBS) — The Senate voted Tuesday in favor on a motion to proceed with debate on the Senate’s health care plan to effectively repeal and replace the Affordable Care Act. On Tuesday night, the Senate Republican plan to repeal and replace the health care law failed on a procedural vote.

The Senate adjourned but will return on Wednesday morning at 9:30 a.m. to resume debate and consideration of amendments to the Republican health care bill. The next series of votes is expected at 11:30 a.m. Eastern.
• After 50 “no” votes on the motion to proceed to debate (including all Democrats plus two Republicans) and 50 “yes” votes from Republicans, Vice President Mike Pence broke the tie
• Sen. John McCain was welcomed back to Senate with standing ovation, votes “yes”
• Senate GOP’s plan to repeal and replace Obamacare, known as BCRA, fails in procedural vote, at about 9:30 p.m.

The first vote was intended to open debate on the American Health Care Act (AHCA), the GOP-sponsored Obamacare replacement plan that passed the House of Representatives in May.

Numerous amendments will now be offered that will dramatically change the nature of the House-passed legislation. Some amendments include a proposal to repeal and replace Obamacare, while another could simply repeal the 2010 health care law in its entirety and provide Congress with two years to figure out a replacement health care plan.

President Donald Trump has publicly pressured Republicans to vote to proceed and find a way to replace Obamacare.

Read this story on the CBS News website for the full list of Tuesday updates while Senate was in session.</s>The Senate has blocked a wide-ranging proposal by Republicans to repeal much of former President Barack Obama's health care law and replace it with a more restrictive plan. New Mexico U.S. Senators Martin Heinrich and Tom Udall both voted against the repeal.

Senators voted 57-43 late Tuesday to reject the plan in the first vote on an amendment to the bill. Those voting "no" included nine defecting Republicans.

The vote underscored problems Republicans will have in winning enough votes to recast Obama's statute.

The rejected proposal included language by Senate Majority Leader Mitch McConnell erasing the Obama law's tax penalties on people not buying insurance and cutting Medicaid.

Language by Texas Republican Sen. Ted Cruz would let insurers sell cut-rate policies with skimpy coverage. And there was an additional $100 billion to help states ease costs for people losing Medicaid sought by Midwestern moderates.

U.S. Capitol Police say they arrested nearly 100 people during protests over legislation that would roll back much of former President Barack Obama's health care law.

Police spokeswoman Eva Malecki said in a statement that officers responded twice to Senate visitor galleries and once to the atrium of the Hart Senate Office Building on Tuesday afternoon.

She says 31 demonstrators in the visitor galleries were arrested charged with disrupting Congress after they refused to stop their "unlawful demonstration activities."

In the office building, 64 people were arrested and charged with crowding, obstructing or incommoding under District of Columbia code.

The demonstrations came as the Senate voted Tuesday to move forward with the Republicans' long-promised legislation to repeal and replace the Affordable Care Act.

Democrats say the Senate parliamentarian has found additional parts of the Republican health care bill that Democrats can block because they violate Senate rules.

One provision would let insurers charge older people premiums at least five times greater than what younger customers pay. Republicans are trying to repeal much of President Barack Obama's health care overhaul, which limits that ratio to 3-1.

Another provision would let small businesses combine to form so-called association health plans that could be sold across state lines.

The parliamentarian said last week that other language also broke the rules, including blocking federal money to Planned Parenthood.

Republicans said the ruling was advisory and they'd try adjusting the language.

Provisions breaking rules need 60 votes to pass, more than the GOP has.

President Donald Trump is praising the Senate for moving forward on health care repeal.

He says a vote Tuesday to take up the Republican health care bill "was a big step."

Trump is speaking at a joint press conference with Lebanese Prime Minister Saad Hariri (sahd hah-REER'-ee).

Trump is also thanking Arizona Sen. John McCain, who returned to Washington his brain cancer diagnosis, to cast a vote.

Trump adds that he wants "to congratulate the American people" because better health care is on the way.

The Senate has voted to move ahead on health care legislation aimed at dismantling the Obama health law.

The vote was 51-50 on Tuesday, a victory for Majority Leader Mitch McConnell and President Donald Trump. Last week, McConnell was forced to postpone the vote, lacking the support of conservatives and moderates.

In a dramatic turn, Sen. John McCain returned from Arizona where he is battling brain cancer to cast a crucial vote on proceeding on health care.

The vote sets up days of debate and votes on repealing and replacing Barack Obama's health care law. Whatever the Senate approves still requires a vote in the House.

Protesters temporarily disrupted the Senate proceedings on the health care bill.

Shouting "Kill the bill" and "shame," the demonstrators stood in the visitors' gallery and chanted. They were led out of the chamber by police but could still be heard.

The vote got underway on moving head on health care with the goal of erasing much of Barack Obama's law. The Senate chamber was packed, with lawmakers standing to cast their votes.

Senate Majority Leader Mitch McConnell is urging his colleagues to move ahead on health care legislation with the goal of erasing much of the Obama health law.

McConnell told senators seated in the Senate chamber: "We cannot let this moment slip by." He made the remarks ahead of a make-or-break vote to take up the bill. The Kentucky Republican said many GOP senators waited for years for the opportunity to scuttle the 2010 law.

Democratic leader Chuck Schumer urged lawmakers to reject it, saying, "Turn back now before it's too late."

A vote to move ahead would set up days of debate and votes. Republicans have promised for seven years to repeal and replace the law.

As McConnell set up the vote, protests erupted, chanting, "Kill the bill."

West Virginia Sen. Shelley Moore Capito has become the latest wavering Republican to say they will back beginning debate on legislation rolling back much of President Barack Obama's health care law.

Capito has been among several moderate Republicans concerned about the GOP bill's cuts in the Medicaid health care program for the poor, disabled and nursing home residents. She's also pushed for added funding for programs that help combat the abuse of drugs including opioids.

West Virginia is one of the nation's poorest states and has an unusually serious drug abuse problem.

Capito says as the Senate debates the bill, she'll push for policies "that result in affordable health care coverage for West Virginians."

A Senate Republican who hadn't declared how he'd vote on repealing much of the Obama health care law says he'll vote Tuesday to begin debate.

Nevada Sen. Dean Heller's statement was crucial because GOP leaders can only lose two of the 52 Republican senators and keep the bill alive. Around a dozen declared opposition or lambasted the legislation, but many seemed to be falling into line.

Heller faces perhaps the toughest re-election race next year of any Senate Republican. He and his state's popular Republican governor, Brian Sandoval, have opposed the GOP bill because of its Medicaid cuts.

Heller said in a statement that doing nothing to solve problems with President Barack Obama's law wasn't tenable. He said he'd oppose the final bill if it's not improved for Nevada.

Sen. Rand Paul says he will vote "yes" on a pivotal health care vote Tuesday afternoon after receiving assurances from Majority Leader Mitch McConnell.

Paul had been a holdout against McConnell's plans for legislation to repeal and replace "Obamacare." He argued it did not go far enough in getting rid of the Obama law.

But Paul says McConnell has informed him the Senate will take up a straight-forward repeal bill as he has been urging. And if that's the case he will vote "yes" to open debate on the legislation.

Tuesday's vote is make-or-break because if the Senate does not vote to open debate the bill will die.

But if debate starts there will be numerous amendments — and repeal-only is not likely to be the final product.

Republicans are showing signs of optimism that they'll be able to take up the health care bill. Senators and aides said talks were continuing that might win over enough Republicans to start debate Tuesday.

The discussions involved holding an early vote on a plan scuttling much of the Obama health law and giving Congress two years to enact a replacement. That plan, embraced by conservative Sen. Rand Paul, R-Ky., seems likely to lose. But Paul has said that he will vote to bring up the GOP health bill if he is guaranteed that early vote.

Moderates are 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 want 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.

President Donald Trump says "we will soon see whether or not Republicans are willing to step up to the plate!" on health care.

Trump has been pressuring Senate Republicans to vote on a health care bill "after 7 years of talking." A procedural vote is planned for Tuesday.

Trump says on Twitter Tuesday morning that Obamacare is "torturing" Americans. He says "I have pen in hand" to sign a bill and is urging a vote either to repeal, or to repeal and replace the Obama law.

Trump says it's "so great" that ailing Republican Arizona Sen. John McCain is returning to Washington to vote for the first time since being diagnosed with brain cancer.

Trump's describes McCain's move as "brave" and the senator as an "American hero." During the 2016 campaign, Trump questioned McCain's status as a war hero, saying, "He was a war hero because he was captured. I like people who weren't captured."

Republican leaders are steering the Senate toward a crucial vote on their health care bill with a fresh burst of drama and optimism, thanks to Sen. John McCain's declaration that he'll return to the Capitol for the roll call.

Before the announcement by the cancer-stricken McCain, Senate Majority Leader Mitch McConnell had already planned an initial vote for Tuesday on simply beginning debate on the Republican effort. A victory seemed unlikely because of opposition and criticism from GOP senators toward McConnell's bill, which would erase much of President Barack Obama's law.

McCain's office announced his decision to return late Monday, improving McConnell's odds. In fact, McCain's announcement suggested Republican leaders had a good chance of prevailing since it seemed unlikely they'd bring him back if the measure was doomed.

WASHINGTON (AP) — The Latest on the effort by congressional Republicans to pass a health care bill (all times local):

The Senate has blocked a wide-ranging proposal by Republicans to repeal much of former President Barack Obama's health care law and replace it with a more restrictive plan.

Senators voted 57-43 late Tuesday to reject the plan in the first vote on an amendment to the bill. Those voting "no" included nine defecting Republicans.

The vote underscored problems Republicans will have in winning enough votes to recast Obama's statute.

The rejected proposal included language by Senate Majority Leader Mitch McConnell erasing the Obama law's tax penalties on people not buying insurance and cutting Medicaid.

Language by Texas Republican Sen. Ted Cruz would let insurers sell cut-rate policies with skimpy coverage. And there was an additional $100 billion to help states ease costs for people losing Medicaid sought by Midwestern moderates.

U.S. Capitol Police say they arrested nearly 100 people during protests over legislation that would roll back much of former President Barack Obama's health care law.

Police spokeswoman Eva Malecki said in a statement that officers responded twice to Senate visitor galleries and once to the atrium of the Hart Senate Office Building on Tuesday afternoon.

She says 31 demonstrators in the visitor galleries were arrested charged with disrupting Congress after they refused to stop their "unlawful demonstration activities."

In the office building, 64 people were arrested and charged with crowding, obstructing or incommoding under District of Columbia code.

The demonstrations came as the Senate voted Tuesday to move forward with the Republicans' long-promised legislation to repeal and replace the Affordable Care Act.

Democrats say the Senate parliamentarian has found additional parts of the Republican health care bill that Democrats can block because they violate Senate rules.

One provision would let insurers charge older people premiums at least five times greater than what younger customers pay. Republicans are trying to repeal much of President Barack Obama's health care overhaul, which limits that ratio to 3-1.

Another provision would let small businesses combine to form so-called association health plans that could be sold across state lines.

The parliamentarian said last week that other language also broke the rules, including blocking federal money to Planned Parenthood.

Republicans said the ruling was advisory and they'd try adjusting the language.

Provisions breaking rules need 60 votes to pass, more than the GOP has.

President Donald Trump is praising the Senate for moving forward on health care repeal.

He says a vote Tuesday to take up the Republican health care bill "was a big step."

Trump is speaking at a joint press conference with Lebanese Prime Minister Saad Hariri (sahd hah-REER'-ee).

Trump is also thanking Arizona Sen. John McCain, who returned to Washington his brain cancer diagnosis, to cast a vote.

Trump adds that he wants "to congratulate the American people" because better health care is on the way.

The Senate has voted to move ahead on health care legislation aimed at dismantling the Obama health law.

The vote was 51-50 on Tuesday, a victory for Majority Leader Mitch McConnell and President Donald Trump. Last week, McConnell was forced to postpone the vote, lacking the support of conservatives and moderates.

In a dramatic turn, Sen. John McCain returned from Arizona where he is battling brain cancer to cast a crucial vote on proceeding on health care.

The vote sets up days of debate and votes on repealing and replacing Barack Obama's health care law. Whatever the Senate approves still requires a vote in the House.

Protesters temporarily disrupted the Senate proceedings on the health care bill.

Shouting "Kill the bill" and "shame," the demonstrators stood in the visitors' gallery and chanted. They were led out of the chamber by police but could still be heard.

The vote got underway on moving head on health care with the goal of erasing much of Barack Obama's law. The Senate chamber was packed, with lawmakers standing to cast their votes.

Senate Majority Leader Mitch McConnell is urging his colleagues to move ahead on health care legislation with the goal of erasing much of the Obama health law.

McConnell told senators seated in the Senate chamber: "We cannot let this moment slip by." He made the remarks ahead of a make-or-break vote to take up the bill. The Kentucky Republican said many GOP senators waited for years for the opportunity to scuttle the 2010 law.

Democratic leader Chuck Schumer urged lawmakers to reject it, saying, "Turn back now before it's too late."

A vote to move ahead would set up days of debate and votes. Republicans have promised for seven years to repeal and replace the law.

As McConnell set up the vote, protests erupted, chanting, "Kill the bill."

West Virginia Sen. Shelley Moore Capito has become the latest wavering Republican to say they will back beginning debate on legislation rolling back much of President Barack Obama's health care law.

Capito has been among several moderate Republicans concerned about the GOP bill's cuts in the Medicaid health care program for the poor, disabled and nursing home residents. She's also pushed for added funding for programs that help combat the abuse of drugs including opioids.

West Virginia is one of the nation's poorest states and has an unusually serious drug abuse problem.

Capito says as the Senate debates the bill, she'll push for policies "that result in affordable health care coverage for West Virginians."

A Senate Republican who hadn't declared how he'd vote on repealing much of the Obama health care law says he'll vote Tuesday to begin debate.

Nevada Sen. Dean Heller's statement was crucial because GOP leaders can only lose two of the 52 Republican senators and keep the bill alive. Around a dozen declared opposition or lambasted the legislation, but many seemed to be falling into line.

Heller faces perhaps the toughest re-election race next year of any Senate Republican. He and his state's popular Republican governor, Brian Sandoval, have opposed the GOP bill because of its Medicaid cuts.

Heller said in a statement that doing nothing to solve problems with President Barack Obama's law wasn't tenable. He said he'd oppose the final bill if it's not improved for Nevada.

Sen. Rand Paul says he will vote "yes" on a pivotal health care vote Tuesday afternoon after receiving assurances from Majority Leader Mitch McConnell.

Paul had been a holdout against McConnell's plans for legislation to repeal and replace "Obamacare." He argued it did not go far enough in getting rid of the Obama law.

But Paul says McConnell has informed him the Senate will take up a straight-forward repeal bill as he has been urging. And if that's the case he will vote "yes" to open debate on the legislation.

Tuesday's vote is make-or-break because if the Senate does not vote to open debate the bill will die.

But if debate starts there will be numerous amendments — and repeal-only is not likely to be the final product.

Republicans are showing signs of optimism that they'll be able to take up the health care bill. Senators and aides said talks were continuing that might win over enough Republicans to start debate Tuesday.

The discussions involved holding an early vote on a plan scuttling much of the Obama health law and giving Congress two years to enact a replacement. That plan, embraced by conservative Sen. Rand Paul, R-Ky., seems likely to lose. But Paul has said that he will vote to bring up the GOP health bill if he is guaranteed that early vote.

Moderates are 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 want 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.

President Donald Trump says "we will soon see whether or not Republicans are willing to step up to the plate!" on health care.

Trump has been pressuring Senate Republicans to vote on a health care bill "after 7 years of talking." A procedural vote is planned for Tuesday.

Trump says on Twitter Tuesday morning that Obamacare is "torturing" Americans. He says "I have pen in hand" to sign a bill and is urging a vote either to repeal, or to repeal and replace the Obama law.

Trump says it's "so great" that ailing Republican Arizona Sen. John McCain is returning to Washington to vote for the first time since being diagnosed with brain cancer.

Trump's describes McCain's move as "brave" and the senator as an "American hero." During the 2016 campaign, Trump questioned McCain's status as a war hero, saying, "He was a war hero because he was captured. I like people who weren't captured."

Republican leaders are steering the Senate toward a crucial vote on their health care bill with a fresh burst of drama and optimism, thanks to Sen. John McCain's declaration that he'll return to the Capitol for the roll call.

Before the announcement by the cancer-stricken McCain, Senate Majority Leader Mitch McConnell had already planned an initial vote for Tuesday on simply beginning debate on the Republican effort. A victory seemed unlikely because of opposition and criticism from GOP senators toward McConnell's bill, which would erase much of President Barack Obama's law.

McCain's office announced his decision to return late Monday, improving McConnell's odds. In fact, McCain's announcement suggested Republican leaders had a good chance of prevailing since it seemed unlikely they'd bring him back if the measure was doomed.</s>WASHINGTON - The Senate voted Wednesday to defeat a bill that would have repealed Obamacare within two years without any immediate plan to replace the sweeping health care law.

Senators voted 45-55 in favor of the bill, falling six votes short of the 51 needed to pass it. Seven Republicans voted against it: John McCain of Arizona, Dean Heller of Nevada, Susan Collins of Maine, Rob Portman of Ohio, Lamar Alexander of Tennessee, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia.

The vote comes on the second day of a 20-hour Senate debate on health care as Republican leaders scramble to win enough votes from their own members to pass something to replace the Affordable Care Act. The Senate began its session Wednesday morning with about 17 hours left in the debate.

Here's a look at where things stand now:

What are they voting on today?

The big vote so far was the failed attempt to pass the amendment by Sen. Rand Paul, R-Ky., to repeal the Affordable Care Act within two years, which would have given lawmakers time to come up with a replacement plan before the law expired. The proposal is the same as one passed by Congress in 2015, which was vetoed by former president Barack Obama. Collins is the only Republican senator who voted against the bill both times.

With a Republican president in the White House, GOP leaders tried again. Paul and other conservatives have led the push for a complete repeal of Obamacare. But there has been a lot of hesitation among Republicans for "repeal" without a plan for "replace."

What have they already voted on?

On Tuesday, senators voted 50-50 to begin debate on a health care bill. Vice President Pence had to come to the Senate chamber to break the tie and allow debate to start.

After that, the biggest news came Tuesday night when senators defeated a Republican bill, on a vote of 43-57, to replace Obamacare. Nine Republican senators voted against the legislation, which was drafted by Senate Republican leaders.

It included a proposal by Sen. Ted Cruz, R-Texas, to allow insurers to sell bare-bones health care plans that don't cover maternity care and other major benefits as long as the companies also sell plans that include a full range of benefits.

The defeated plan also included a proposal by Sen. Rob Portman, R-Ohio, to provide $100 billion in aid to help low-income Americans pay their medical bills after they lose Medicaid coverage as a result of the Senate health care bill.

What are Democrats doing?

The Democrats have been voting against the Republican bills to repeal and replace Obamacare. They also are using procedural tactics to try to slow down the debate process.

For example, Sen. Joe Donnelly, D-Ind., will offer a motion Wednesday to send health care legislation back to the Finance Committee for consideration. On Tuesday, they objected to the usual Senate practice of waiving the reading of the bill, so Senate clerks had to spend several hours reading the leadership replacement bill aloud.

What happens after the 20 hours of debate are over?

A vote-a-rama will begin on dozens of amendments offered by senators of both parties. That is expected to start Thursday.

Do Republican Senate leaders have an endgame?

With the defeat of the comprehensive replacement bill and the "clean" repeal bill, GOP leaders are now looking to pass a "skinny repeal" bill that would make limited changes to Obamacare. It would likely strip out the law's tax on medical devices and its requirements for individuals to buy health insurance and large employers to provide coverage for their workers.

If that plan passes the Senate, it would most likely go to a conference committee of House and Senate negotiators who would try to work out a final compromise.

Democrats say Senate leaders just want to pass anything they can take to this conference committee, where the real bill would be crafted.

"It's becoming clearer that, in the end, the majority leader might push a much scaled-back version of repeal in the hopes of passing something, so-called skinny repeal, just to get to conference," Minority Leader Chuck Schumer, D-N.Y., said in a speech on the Senate floor Wednesday. "But my colleagues, make no mistake about it, skinny repeal is equal to full repeal. It's a Trojan horse designed to get the House and Senate into conference where the hard-right flank of the Republican Caucus, the (House) Freedom Caucus, will demand full repeal or something very close to it."

Why has it been so difficult for the Senate to reach agreement?

Republican leaders have been trying to please the conservative and moderate wings of their party, and they have so far failed to win the support of both groups.

Conservatives generally want a complete repeal of Obamacare's taxes and regulations while moderates worry that ending the law's Medicaid expansion will leave struggling Americans with no way to afford medical coverage.

"Ultimately, we want to get legislation to finally end the failed Obamacare status quo through Congress and to the president’s desk for his signature," Majority Leader Mitch McConnell, R-Ky., said Wednesday in a speech on the Senate floor. "This certainly won’t be easy. Hardly anything in this process has been."</s>Senator Dianne Feinstein (D-CA) arrives for a health care vote on Capitol Hill in Washington, July 26, 2017. — Reuters picWASHINGTON, July 27 — US Senate Republicans suffered a second stinging setback in as many days yesterday in their efforts to uproot Obamacare, when a plan to repeal the health care law, with no replacement at the ready, failed to advance in the chamber.

The washout has left Republicans — who only a day early rejoiced when the Senate agreed to proceed to a formal debate on health care — struggling to find consensus on how to fulfill President Donald Trump’s pledge to scrap the 2010 Affordable Care Act.

Senate leaders have said they intend to pass a bill by the end of this week, but that path remained murky — and the outcome in doubt.

Seven Republicans joined Democrats in opposing yesterday’s proposal, which would have ended Obamacare’s insurance exchanges and its taxes on the wealthy; rolled back the expansion of Medicaid, the health insurance program for the poor and the disabled; and ended mandates compelling individuals to have insurance and for companies to provide it.

The non-partisan Congressional Budget Office had forecasted that 32 million Americans would become uninsured over the next decade should the bill become law.

The defeat came just hours after the Senate voted down a broader Republican plan to repeal and replace Barack Obama’s signature health care reforms.

It was a bleak set of outcomes for Republicans after a whirlwind session Tuesday at which Senator John McCain, recently diagnosed with brain cancer, earned a warm ovation as he returned to the Senate to cast key votes.

While Trump had applauded Republicans for finally moving to a debate that could lead to “truly great health care for the American people,” the moment of victory proved temporary.

Under pressure to emerge with tangible results, Senate Majority Leader Mitch McConnell was putting a variety of options forward.

“I know members in both parties have health care ideas they’d like to offer,” he said. “If you’ve got one, bring it to the floor.”

Frustration was setting in with some members including Senator Ben Sasse, who raked fellow Republicans over the coals for failing to follow through on their seven-year promise to dismantle Obamacare.

“Make no mistake: Today’s vote is a major disappointment to people who were promised full repeal,” he said in a statement.

“We still have a long, long way to go.”

One new approach in order to keep the effort afloat was gaining traction: a limited dismantling of Obamacare.

The so-called “skinny repeal” would ditch the provision that fines individuals for not having insurance and companies that don’t offer it. It also would eliminate a tax on medical-device manufacturers.

The Republican leadership does not expect the pared-down bill to become law. But should it pass the Senate, it could be used as a placeholder, a basis for negotiating broader legislation with the House of Representatives.

The approach drew sharp criticism from Democrats, who have warned that an Obamacare repeal would result in deep cuts to Medicaid and prohibitively high insurance premiums for people with pre-existing conditions.

“It’s a Trojan horse, designed to get the House and Senate into conference, where the hard right flank of the House Republicans, the Freedom Caucus, will demand full repeal, or something very close to it,” top Senate Democrat Chuck Schumer warned.

“There’s no good way out of this,” he added.

The House passed its Obamacare repeal and replace bill in May, but it stalled in the Senate, which was intent on crafting its own version.

The two would need to be reconciled and a final bill passed by both chambers before it reaches the president’s desk.

But with deep fissures within the Republican Party, a failure to approve any health reform plan remained a possibility.

With the pressure building, the White House sounded vexed about Republicans’ powerlessness, especially since the party controls both chambers of Congress.

Trump is “hoping they’ll join him in pushing forward a lot of the policies that most of those people campaigned on, like repealing and replacing Obamacare,” White House spokeswoman Sarah Huckabee Sanders said.

Republicans need to “step up to commitments that they made during the campaign and since being elected”. — AFP
The United States Senate rejects "repeal only" propositions of the Patient Protection and Affordable Care Act. United States President Donald Trump lashes out at Republican Senator Lisa Murkowski, who voted against the proposal.