WASHINGTON, D.C. 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.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.”Replacement health care plans have faced uphill battles on both chambers. Democrats have seized on a July report from the Congressional Budget Office that said 22 million people would lose health insurance under the Senate’s proposed replacement for Obamacare. However, the report also says that 15 million of those people would lose it simply because the individual mandate, the requirement to purchase insurance, was ended in the new plan. Analysts estimate that 75 percent of those who would no longer have insurance without the mandate would do so because they were no longer required under penalty of law to have it.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.His appearance is critical and some say symbolic of the Republican’s effort to make good on their campaign promise to repeal Obamacare, the signature policy initiative of the former administration. The controversial law has increased premiums and reduced health care options for millions of Americans since it’s passage seven years ago. Trump also ran on its repeal and has been stepping up the pressure on lawmakers behind closed doors and in social media over the past several days.McCain, 80, a veteran senator and former Republican presidential candidate known as a strong and sometimes fiercely independent voice on defense and security issues, was found to have an aggressive form of brain tumor, glioblastoma, after surgery last week for a blood clot above his left eye. It is the same kind of cancer that claimed the life of Sen. Ted Kennedy (D-Mass.)McCain’s doctors said he was recovering from surgery well, and praised his underlying health as excellent with no sign of neurological impairment before or during his surgery.”John McCain is an American hero and a fighter through and through,” said Sen. Thom Tillis (R-N.C.). “Courage and fearlessness have always defined his distinguished career of public service. Susan and I join all North Carolinians in praying for Sen. McCain’s recovery and return to the United States Senate.”McCain is also known for an independent streak and a willingness to work with Democrats. He has participated in almost every major bipartisan legislative effort in the Senate in recent years, such as the “Gang of Eight” immigration push in 2013. He called for more defense spending but also criticized what he sees as inefficiencies in U.S. weapons programs.For now, Republicans had McCain for Tuesday’s critical health care vote and, according to close allies, he is expected to remain active in the Senate and the party.
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