Senate Majority Leader Mitch McConnell walks to a meeting in the U.S. Capitol on July 25, 2017 in Washington. The U.S. Senate is scheduled to hold a key procedural vote later today on U.S. President Donald Trump's effort to repeal and replace the Affordable Care Act.

Win McNamee / Getty Images</s>Senate Majority Leader Mitch McConnell of Ky. walks to the Senate Chamber on Capitol Hill in Washington, Tuesday, July 25, 2017. (AAP)

Republicans have won a narrow vote in the United States Senate to begin formal debate of healthcare legislation as they look to repeal Obamacare.

The US Senate has voted to begin formal debate of healthcare legislation that would repeal major elements of Obamacare and possibly replace it with a less costly program.

By a vote of 51-50, with Vice President Mike Pence breaking a tie, the Republican effort cleared an important procedural hurdle in the Senate, but it was still unclear whether there would eventually be enough votes to pass a bill.

The outcome was a huge relief for President Donald Trump, who had pushed his fellow Republicans hard in recent days to live up to the party's campaign promises to repeal the 2010 Affordable Care Act, commonly known as Obamacare.

Senator John McCain, who has been battling brain cancer at home in Arizona, made a dramatic return to the Capitol to cast a vote to open the healthcare debate. He received an ovation from his fellow senators when he entered the chamber.

Senators Susan Collins and Lisa Murkowski were the only Republicans to oppose the measure. Democrats were united in opposition to the motion to proceed.

A loss on Tuesday could have been a death blow for Republican efforts to repeal Obamacare, and also cast doubt on Trump's prospects to achieve any of his other top legislative agenda items, including tax reform.

"We have a duty to act," Senate Majority Leader Mitch McConnell told senators before the vote, reminding Republicans they had promised to repeal Obamacare in four straight elections. "We can't let this moment slip by."

As the vote opened, more than two dozen protesters in the Senate chamber chanted "kill the bill" before they were removed.

The Senate will now launch what McConnell has promised will be a robust debate on healthcare that could include a variety of amendments.

Senators said a variety of approaches have been discussed, including a straight repeal of Obamacare with no replacement plan, or repealing and replacing the law while also overhauling Medicaid, the federal health insurance program for the poor and disabled.

Senate Republicans also could consider a shortened version of repeal, called a "skinny repeal," that would end Obamacare's individual and employer mandates and the medical device tax, a Senate aide and a lobbyist said.</s>Republicans in the U.S. Senate fell short again on Wednesday in their effort to end Obamacare, rejecting a measure to repeal large portions of President Barack Obama’s signature law that has provided health insurance to millions of Americans.

WASHINGTON — Republicans in the U.S. Senate fell short again on Wednesday in their effort to end Obamacare, rejecting a measure to repeal large portions of President Barack Obama’s signature law that has provided health insurance to millions of Americans.

But Republican Senate leaders, struggling to keep a seven-year-old promise to unravel the law, already were trying to gain support for a slimmed-down “skinny” bill that would throw the issue to a Senate-House of Representatives negotiating committee.

Republican senators said they were still determining what would be in the skinny repeal, which could simply eliminate mandates requiring individuals and employers to obtain or provide health insurance, and abolish a tax on medical device manufacturers.

Sen. John Thune, the No. 3 Senate Republican, said the party was trying to “figure out what the traffic will bear, in terms of getting 50 of our members to vote for things that will repeal as much of Obamacare as possible.”

The discussions came as the Senate rejected 45-55 a straight repeal of Obamacare with a two-year delay in implementation to allow Congress to work out a replacement. Seven Republicans opposed the measure: Dean Heller of Nevada, Susan Collins of Maine, Lisa Murkowski of Alaska, Lamar Alexander of Tennessee, Shelley Moore Capito of West Virginia, John McCain of Arizona and Rob Portman of Ohio.

Any Senate legislation would be enough to kick the issue to a special negotiating committee with the House, which passed its own version in May. If that panel can agree on a new bill, the full House and Senate would again have to approve the legislation — a process that could last for months.

“I think people would look at it not necessarily based on its content, but as a forcing mechanism to cause the two sides of the building to try to solve it together,” Republican Sen. Bob Corker said. “That’s going to be the last chance.”

It was the Senate’s second failure in 24 hours to repeal the 2010 law popularly known as Obamacare, which expanded health insurance to about 20 million people, many of them low-income.

The Senate on Tuesday rejected the repeal-and-replace plan Republicans had been working on since May, with nine of the 52 Republicans voting against it.

That failed vote, and a narrow 51-50 decision to open debate on the issue, with Vice President Mike Pence casting the tie-breaking vote, underscored the party’s deep divisions on the role of government in helping provide access to healthcare.

The Senate plans more votes on other approaches in coming days in a freewheeling debate that could stretch through the week. It is also a test of how Republicans govern, now that they control both Congress and the White House.

President Donald Trump, who has been in office for six months, has come down hard on his fellow Republicans for failing to act on Obamacare, something that he had promised repeatedly in his election campaign last year. Some Senate Republicans were growing uncomfortable with the chaotic debate.

“We’ve got to have a more organized process,” Republican Sen. Ron Johnson said, noting the skinny repeal would simply kick the issue down the road. “We just don’t have the courage and really the intestinal fortitude to suck it up and … do this right.”</s>The US Senate voted to begin debate on how to repeal and, eventually, replace the healthcare reform implemented by former President Barack Obama, although it is still not known what the final form of the bill might be.

Vice President Mike Pence on Tuesday, presiding over the Upper House, had to use his tiebreaking authority to overcome the impasse between Republicans and Democrats, given that conservative Senators Susan Collins and Lisa Murkowski voted against the motion to begin debate on the bill, Efe news reported.

Senate Republicans are not in agreement on how to overturn ObamaCare, but President Donald Trump has been relentlessly pressuring the GOP to push forward with some kind of healthcare reform and Senate Majority Leader Mitch McConnell convened the vote to begin debate without a concrete text for the bill in hand.

So far, the three bills presented to attempt to overturn ObamaCare have not managed to garner Republican consensus, and thus Trump and the party -- although it holds a majority in the Senate -- have been unable to fulfill one of their key campaign promises.

Senator John McCain of Arizona, despite his recent diagnosis of brain cancer, returned to Washington exclusively for Tuesday's session so that he could vote on the motion to begin debate on the health care matter.

McCain reportedly voted to begin debate, despite the fact that various analyses have estimated that some 24 million people would lose their health care coverage over the next decade if Republicans manage to push through some kind of bill to overturn ObamaCare.

All Senate Democrats, along with Collins and Murkowski, voted against the motion to begin debate.

However, about half a dozen Republican lawmakers kept their cards close to the vest until the last moment on how they would vote, having expressed serious doubts about the legislative alternatives to ObamaCare presented to date.

In the meantime, the mini-victory does not guarantee that Republicans will be able to find consensus within their ranks for some kind of bill to repeal ObamaCare.</s>WASHINGTON — Republicans narrowly advanced their campaign to roll back the Affordable Care Act on Tuesday, as the Senate voted by a slim margin to begin debating legislation to repeal and potentially replace large sections of the 2010 law signed by President Barack Obama.

But the partisan 51-50 vote — with Vice President Mike Pence breaking a tie — does not assure the success of the GOP’s seven-year quest to dismantle the sweeping law, often called Obamacare.

With health coverage for tens of millions of Americans at stake, it remained unclear Tuesday what kind of health care bill — if any — might emerge by the time a final Senate vote is held, possibly as early as Thursday.

Senate Majority Leader Mitch McConnell, R-Kentucky, has set up a series of votes this week on competing proposals to repeal much of Obamacare, or repeal and replace pieces of the law.

Tuesday’s procedural vote to kick off that process marks a victory for McConnell, who has been laboring for months behind closed doors to rally his divided caucus, and for President Donald Trump, who has been publicly calling out GOP senators to stick with the repeal push.

But to get to the vote, McConnell abandoned customary legislative process, foregoing public hearings and committee debate in a way almost never seen for major legislative proposals.

And he left Republican lawmakers with a series of legislative options — which polls show are also deeply unpopular with Americans — that would leave as many as 32 million more people without health coverage and weaken health protections for tens of millions more.

The GOP plans have been widely panned by independent analysts and vigorously opposed by every major patient advocacy group and every leading organization representing physicians, nurses and hospitals.

Opponents include the American Diabetes Association, the March of Dimes, the AARP, the American Medical Association, the American Lung Association, the National Multiple Sclerosis Society, the American Heart Association and the advocacy arm of the American Cancer Society.

Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted against the motion.

Collins posted on Twitter on Tuesday afternoon that she voted against the motion to proceed with debate on the bill because “when dealing w/ a complex issue that affects millions of Americans & ⅙th of our economy, we must proceed carefully.”

“Making sweeping changes to the 50-year-old Medicaid program without a single Senate hearing is a mistake,” she tweeted. “We must work in a bipartisan way to to fix the ACA’s serious flaws.”

In a statement Tuesday, Maine’s junior senator, independent Angus King, called the legislation “misguided,” adding that any version of the bill “will hurt millions of people across the country and tens of thousands of hardworking people across Maine.”

“I’ve never seen a process like this before with no hearings and it will almost certainly produce a terrible bill that will drastically raise costs for people in Maine, put coverage out of reach for many others, and reduce Medicaid funding, causing states to choose between helping seniors or children or people with disabilities,” King said. “As the Senate advances with this bill, I will continue to support and protect people in Maine and work to find solutions that keep people covered and make health care more affordable.”

GOP leaders were aided by the dramatic return to the Capitol by Sen. John McCain, R-Arizona, after surgery last week and a diagnosis of brain cancer. He arrived in the chamber to cheers and a standing ovation from his colleagues.

As Republicans next move to crafting a final bill, one leading GOP option, favored by conservatives, is to simply repeal most major parts of Obamacare, and then try to pass a new health care law in the future.

Another idea, supported at one point by GOP leaders, would replace most of the law while at the same time dramatically scaling back federal funding of the Medicaid insurance program that covers some 74 million low-income, elderly and disabled Americans.

GOP centrists have complained both of those versions would leave too many Americans without insurance, and have urged McConnell to start the process over, working on a bipartisan approach that will protect those covered under Obamacare.

So far, none of these approaches has garnered the necessary 50 votes from the Republicans’ 52-seat Senate majority.

The lack of GOP consensus prompted Senate Republican leaders to float a new idea Tuesday — a far more limited repeal bill that would target the most unpopular parts of Obamacare, including its insurance mandates.

That plan — dubbed “skinny repeal” — would eliminate only a medical device tax established by Obamacare and two mandates requiring Americans to have coverage and requiring large employers to offer health benefits.

The approach would fall far short of what Republicans have been promising for years.

If it passes, Senate Republicans could at least send something to a conference committee where lawmakers could work out a compromise with a sweeping repeal bill passed by House Republicans in May, giving them yet another shot at unwinding Obamacare.

That would all have to be done without Democrats, who remain fiercely opposed to the GOP repeal push and voted together Tuesday to try to block the beginning of Senate debate.

The skinny repeal plan risks major disruptions to the nation’s insurance markets, as the lack of any insurance mandate could free Americans to buy health insurance only when they get sick, driving up costs.

But it would leave in place other critical parts of the 2010 law, including hundreds of billions of dollars of federal aid to state Medicaid programs and insurance subsidies that help low- and moderate-income Americans

That assistance is credited with helping extend coverage to more than 20 million previously uninsured Americans.

Also untouched would be landmark rules established by Obamacare that require insurers to cover a basic set of benefits and prohibits health plans from discriminating against Americans with preexisting medical conditions.

It remains unclear whether House Republicans would agree to this more limited repeal plan.

But with centrist and conservative GOP senators in deep disagreement, the skinny repeal may be all McConnell can pass.

The repeal-only plan — which is favored by the most conservative GOP senators — would leave an estimated 32 million more people without health coverage over the next decade, according to the nonpartisan Congressional Budget Office, or CBO.

It is opposed by multiple centrist GOP senators.

The alternative proposed by McConnell that repeals and replaces major parts of the law while also dramatically scaling back federal Medicaid assistance is only slightly less disruptive, CBO analysts have concluded.

The McConnell proposal, which has drawn fire from both centrist and conservative Republicans, would leave 22 million more Americans without insurance by 2026.

That plan would be most devastating to the Medicaid safety net, which currently covers some 70 million poor Americans, including children. Federal Medicaid funding would be reduced by more than a third over the next two decades.

And while CBO concluded the “repeal-and-replace” plan could lower premiums for some consumers, it would likely put health insurance out of reach for older and sicker Americans who could be forced to pay larger deductibles or higher premiums than under the current law.

Still unclear is the effect of yet other GOP proposals that could come up for votes in coming days, including one by Sen. Ted Cruz, R-Texas, to allow health insurers to sell skimpier plans that do not include basic benefits such as prescription drugs, maternity care and mental health and substance abuse services.

The Cruz proposal is widely expected to make health coverage more expensive for sick Americans who need to buy more extensive health coverage and has been panned by health insurers as “unworkable.”

But McConnell elected to proceed with voting Tuesday before CBO had an opportunity to assess the potential impact of Cruz’s proposal.</s>WASHINGTON (NBC) — Senate Republicans were dealt a blow late Tuesday night when a bill to repeal major parts of the Affordable Care Act failed.

Just 43 Senators voted for the bill, well short of the 60 required votes to overcome a parliamentary objection.

Nine Republicans voted against the bill, which called for severe cuts to the Medicaid program.

It also included cuts to Obamacare subsidies that help lower income people pay for the cost of health insurance.

This was the first of several expected votes this week which would repeal or replace parts of former President Obama’s health care law.</s>Vice President Mike Pence forced to cast the tie-breaking vote on moving forward with the senate healthcare debate.

US Senate Republicans narrowly agreed on Tuesday to open debate on a bill to end Obamacare, but the party's seven-year effort to roll back Democratic President Barack Obama's signature healthcare law still faces significant hurdles.

The senate deadlocked 50-50 on moving forward with the healthcare debate, forcing Vice President Mike Pence to cast the tie-breaking vote.

Senator John McCain, who was diagnosed this month with brain cancer and has been recovering from surgery at home in Arizona, made a dramatic return to the US Capitol to cast a crucial vote in favour of proceeding.

READ MORE: The Obamacare debate is not just about healthcare

The outcome was a huge relief for President Donald Trump, who had pushed his fellow Republicans hard in recent days to live up to the party's campaign promises to repeal the 2010 Affordable Care Act, commonly known as Obamacare. Minutes after the vote, Trump called it "a big step".

But the narrow victory on a simple procedural matter raised questions about whether Republicans can muster the votes necessary to pass any of various approaches to repeal. Moderates are worried repeal will cost low-income Americans their insurance and conservatives are angry the proposed bills do not go far enough to gut Obamacare.

Al Jazeera's Kimberly Halkett, reporting from Washington DC, said that Trump's celebrations were a "premature victory lap".

"[It was very difficult] just to get the passage of that vote just to begin the debate - requiring a senator who has recently been diagnosed with brain cancer pivotal in getting that passed and even having the vice-president being called in to break the tie," said Halkett.

"In no way is there any certainty that [Trump] will be able to deliver legislatively on his key campaign promise to repeal the Affordable Care Act."

John McCain said he voted for the motion to proceed to "allow debate to continue and amendments to be offered".

"I will not vote for the bill as it is today," he said." It's a shell of a bill right now."

'We have a duty to act'

Senators Susan Collins and Lisa Murkowski were the only Republicans to oppose the measure, and with Republicans controlling the Senate by a 52-48 majority, those were the only votes the party leadership could afford to lose. Democrats were united in opposition to the motion to proceed.

Republican Senator Ron Johnson, who cast the last and deciding vote to open debate, engaged in a heated discussion with Senate Majority Leader Mitch McConnell before casting his vote and ending the suspense.

A loss on Tuesday could have been a death blow for Republican efforts to repeal Obamacare, as well as casting doubt on Trump's prospects to achieve any of his other top legislative agenda items, including tax reform.

READ MORE: Can Muslim politicians survive in today's US?

"We have a duty to act," McConnell told senators before the vote, reminding Republicans they had promised to repeal Obamacare in four straight elections. "We can't let this moment slip by."

As the vote opened, more than two dozen protesters in the senate chamber chanted "kill the bill" before they were removed.

The senate will now launch what McConnell has promised will be a robust debate on healthcare that could include a variety of amendments.

Senators said several approaches have been discussed, including a straight repeal of Obamacare with no replacement plan, or repealing and replacing the law while also overhauling Medicaid, the federal health insurance programme for the poor and disabled.

Senate Republicans also could consider a shortened version of repeal, called a "skinny repeal," which would end the mandates in Obamacare on individuals and employers to obtain or provide health insurance, and a medical device tax, a senate aide and a lobbyist said.

"Ultimately they voted on opening debate on an amendment process - that really leaves it wide open in terms of what could look like," said Al Jazeera's Kimberly Halkett.

Halkett said there are only 40 hours of debate scheduled - including 20 hours each for the Republicans and the Democrats.

"It's very hard to see how anything constructive can be accomplished, the prospects for its success are very bleak. At the same time Democrats are digging in deep, intensifying their efforts to see that it fails," she said.</s>Brawl over Obamacare repeal returns to US Senate floor

Senator Lindsey Graham (R-SC) walks to the Senate Floor to vote on the health care bill on Capitol Hill in Washington July 25, 2017. — Reuters picWASHINGTON, July 26 — After a months-long struggle, Republicans have succeeded in bringing Obamacare repeal legislation, a centerpiece of their 2016 election campaigns, to a debate on the US Senate floor. Now the hard part begins.

Republicans, deeply divided over the proper role of the government in helping low-income people receive healthcare, eked out a procedural win on Tuesday when the Senate voted 51-50, with Vice President Mike Pence breaking a tie, to allow debate to start on legislation.

The outcome came as a huge relief to President Donald Trump, who has called Obamacare a “disaster” and pushed fellow Republicans in recent days to follow through on the party’s seven-year quest to roll back the law.

But hours later, Senate Republican leadership suffered a setback when the repeal and replace plan that they had been working on since May failed to get enough votes for approval, with nine out of 52 Republicans voting against it.

Usually, bills reach the floor with a predictable outcome: Senators have received summaries of the legislation to be debated that were written in an open committee process, leaders have counted the number of supporters and opponents, amendments are debated and everybody knows the likely outcome: passage.

All that is out the window now, as the Senate on Wednesday continues a freewheeling debate that could stretch through the week on undoing major portions of former Democratic President Barack Obama’s signature Affordable Care Act, which expanded health insurance to about 20 million people, many of them low-income.

Republican leaders have insisted they can devise a cheaper approach this week and with less government intrusion into consumers’ healthcare decisions than Obamacare.

Democrats and other critics of the Republican effort said it would deprive millions of health coverage.

“We’ve tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them it’s better than nothing, asking us to swallow our doubts and force it past a unified opposition,” Republican Senator John McCain said on Tuesday.

“I don’t think that is going to work in the end. And it probably shouldn’t,” he added.

The veteran Arizona lawmaker made his remarks after receiving a standing ovation from his colleagues, as he returned to the Senate just days after surgery and being diagnosed with brain cancer.

McCain appealed to Senate Majority Leader Mitch McConnell to start over by having a Senate committee, in a bipartisan way, craft new healthcare legislation.

His proposal was promptly ignored.

As senators grind through potentially scores of amendments in coming days - in a process called a “vote-a-rama” - they will have more than McCain’s scorn to worry about.

“We strongly oppose all plans so far to replace the Affordable Care Act and have no confidence lawmakers can overcome the flaws in these proposals,” said America’s Essential Hospitals, a group representing hospitals that treat poor people.

Like McCain, the group urged the Senate, narrowly controlled by Republicans, to halt its work on Obamacare repeal legislation and begin a bipartisan effort on healthcare.

The Republican drive to “repeal and replace” Obamacare has taken many unexpected turns since the House of Representatives began working on its version of legislation last March.

For now, many Republican senators are wondering whether they may end up going to a Plan B - a “skinny” healthcare bill that would simply end Obamacare’s penalties for individuals and employers that do not obtain or provide health insurance, as well as abolish a medical device tax.

It would then be up to a special Senate-House committee to come up with a final bill that could take many turns during the negotiation.

After Tuesday’s nail-biter Senate vote setting up the floor debate, McConnell may have best summed up the landscape facing the chamber’s 100 senators.

“This is just the beginning,” he told reporters. — Reuters</s>WASHINGTON – Republicans finally cleared a key hurdle in their years-long effort to repeal Obamacare, the landmark law that reshaped health care and redefined campaign priorities for multiple election cycles.

Tuesday's high-stakes vote allows the Senate to simply begin debate with a likely vote on a straight repeal bill and perhaps a GOP health care reform plan next week.

The vote narrowly passed along party lines, with Vice President Mike Pence breaking the 50-50 tie.

It was preceded by the dramatic return of Sen. John McCain, who recently announced he has brain cancer. The Arizona lawmaker walked onto the Senate floor to a standing ovation, offering a critically needed vote to help Republicans break the deadlock.

President Donald Trump congratulated his colleagues on Capitol Hill immediately following the vote.

"This was a big step," he proclaimed. "I want to thank Senator John McCain and all of the Republicans."

"I want to congratulate [the] American people," he added. "We're going to give you great health care."

The president used the bully pulpit of the Oval Office to pressure the Senate into action after repeated failed attempts to cobble enough support among the Republican conference for its plan to replace the Affordable Care Act, President Barack Obama's signature domestic achievement.

Ahead of the procedural vote, Senate Majority Leader Mitch McConnell, R-Ky., called it an "important first step toward repealing Obamacare" and addressing its "failures."

"Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare," McConnell said, reiterating President Trump's words.

Republicans who opposed the vote for debate include Sens. Susan Collins of Maine and Lisa Murkowski of Alaska.

Protesters temporarily interrupted with chants of "Kill the bill" and shouts of "Shame."</s>WASHINGTON (Reuters) - U.S. Senate Republicans narrowly agreed on Tuesday to open debate on a bill to repeal Obamacare, but the party’s seven-year effort to roll back Democratic President Barack Obama’s signature healthcare law still faces significant hurdles.

The Senate deadlocked 50-50 on whether to move forward with the healthcare debate, forcing Vice President Mike Pence to cast the tie-breaking vote and send the bill to the Senate floor.

The outcome was a huge relief for President Donald Trump, who had pushed his fellow Republicans hard in recent days to live up to the party’s campaign promises to repeal the 2010 Affordable Care Act, commonly known as Obamacare.

But the narrow victory on a simple procedural matter raised questions about whether Republicans can muster the votes necessary to pass any of the repeal approaches the Senate will consider.

Senator John McCain, who has been battling brain cancer at home in Arizona, made a dramatic return to the Capitol to cast a vote to open the healthcare debate. He received an ovation from his fellow senators when he entered the chamber.

Senators Susan Collins and Lisa Murkowski were the only Republicans to oppose the measure. Democrats were united in opposition to the motion to proceed.

A loss on Tuesday could have been a death blow for Republican efforts to repeal Obamacare, and also cast doubt on Trump’s prospects to achieve any of his other top legislative agenda items, including tax reform.

“We have a duty to act,” Senate Majority Leader Mitch McConnell told senators before the vote, reminding Republicans they had promised to repeal Obamacare in four straight elections. “We can’t let this moment slip by.”

As the vote opened, more than two dozen protesters in the Senate chamber chanted “kill the bill” before they were removed.

The Senate will now launch what McConnell has promised will be a robust debate on healthcare that could include a variety of amendments.

Senators said a variety of approaches have been discussed, including a straight repeal of Obamacare with no replacement plan, or repealing and replacing the law while also overhauling Medicaid, the federal health insurance program for the poor and disabled.

Senate Republicans also could consider a shortened version of repeal, called a “skinny repeal,” that would end Obamacare’s individual and employer mandates and the medical device tax, a Senate aide and a lobbyist said.

“Some of us want clean repeal, some of us want the Senate leadership bill, they’re both going to get a vote early on and I think that’s a fair way to do it,” Republican Senator Rand Paul said. “If either one of them fails and another one succeeds, maybe we can find something in between that actually succeeds.”
The U.S. Senate votes to open debate on repealing and possibly replacing Obamacare.