Senators Richard Burr and Thom Tillis of North Carolina voted to proceed with debate on Republicans’ efforts to repeal the Affordable Care Act on Tuesday, keeping alive their party’s attempt to keep a long-standing campaign promise.
Republicans needed ailing Sen. John McCain of Arizona, who recently was diagnosed with brain cancer, to return to Washington to get to 50 votes, allowing Vice President Mike Pence to cast the tie-breaking vote to move forward with debate. Two Republicans – Maine’s Susan Collins and Alaska’s Lisa Murkowski – voted against the motion to proceed as did all 48 senators who caucus with Democrats.
“I am glad the Senate has finally begun to build a solution to the health care crisis facing our nation. This debate will allow each and every senator the opportunity to bring forward their ideas for consideration through an unlimited amendment process,” Burr said in a statement after the vote. “It is my hope that at the end of this process we will pass legislation fulfilling our promise to the American people: repealing and replacing Obamacare.”
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What happens next is still somewhat uncertain.
After 20 hours of debate, the Senate is expected to vote on a complete repeal of the 2010 health-care overhaul that was President Barack Obama’s signature domestic achievement. The vote is expected to fall short of 50 votes.
The Senate could then vote on its own replacement bill – the Better Care Reconciliation Act – but that would need 60 votes after a procedural ruling by the Senate parliamentarian.
Once that fails, the Senate could move on to a lesser repeal, cherry-picking parts of the ACA for elimination that could muster 50 votes, like the individual mandate to buy health insurance, the mandate for companies of a certain size to cover employees and taxes on medical devices.
If that so-called “skinny repeal” passes the upper chamber, Senate and House members could come together to work out differences between bills in each chamber.
“Over the last several years, Obamacare has hit hardworking North Carolina families with skyrocketing premiums and fewer choices, while small businesses have struggled to comply with the law’s costly and burdensome regulations,” Tillis said. “The status quo of Obamacare is unsustainable, and today’s procedural vote sets the stage for an open amendment process where all senators – Republicans and Democrats alike – will be able to put forward their ideas to reform our nation’s health care system.”
Republicans have campaigned against the ACA since its passage. But after gaining full control of Congress and the White House in November, they’ve found turning those slogans into action difficult. The House needed multiple attempts to pass its American Health Care Act, and the Senate has been stymied by a lack of cohesion among its members.
None of the Republicans’ health-care proposals have been very popular with voters. Some are polling at percentages in the teens. Democrats are eager to use the votes as fodder in the next election, much as Republicans ran against the unpopular Obamacare – which has, as McCain pointed out in a Senate speech after the vote, gained in popularity as the Republican alternatives have been debated.
“No matter which bill moves forward, millions of North Carolinians will lose health insurance. Thousands will die because of it. Medicaid will be gutted, and those suffering from opioid addiction will be left to fight on their own,” said Wayne Goodwin, chairman of the North Carolina Democratic Party. “Our nation’s doctors, patient advocates, business leaders, health insurers, and the American people have all rejected these cruel bills. If Senators Burr and Tillis don’t do the same, they’ll have to answer to the North Carolina people.”