ACA Repeal Advances in the Senate

July 26, 2017

On July 25, the Senate voted to begin debate on the Patient Protection and Affordable Care Act (ACA) repeal legislation, a major step toward the Republican’s goal of ending the ACA. Republicans will now begin work on legislation, with a series of votes expected in the coming days, yet the final outcome remains uncertain.

Sen. John McCain (R-Ariz.), recently diagnosed with brain cancer, entered the chamber to a standing ovation and cast the 50th Republican vote. Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) broke ranks to oppose the measure, forcing Vice President Mike Pence to break a 50-50 tie, making it 51-50 as the final vote. All Democratic Senators opposed the measure.

The vote to proceed is not a guarantee that the fractured Republican caucuses can coalesce around a single health care plan. Now that debate has officially started, Republicans still need to secure 50 votes on a policy plan. Moderates oppose repealing the ACA without a replacement, and conservatives do not like the idea of significantly replacing it.

After a series of votes on amendments, Republicans aim is to enact a bill repealing three parts of the ACA: the individual and employer mandates and the medical device tax. It could be expanded or altered depending on where the bulk of the conference is, as the debate continues.

The goal would be to get an ACA repeal bill through the Senate and to a conference with the House. Or perhaps to pass a bill that the House would accept given opposition among some House members to a bicameral conference committee. Still, that scaled-back approach is already hitting some resistance among some Republican senators.

Up until the final hours, the fate of the motion vote was uncertain. Sen. Rand Paul (R-Ky.), Sen. Shelley Moore Capito (R-W.Va.) and Sen. Dean Heller (R-Nev.) waited until the final hours before the vote to announce they would support opening debate on the bill.

Senate Majority Leader Mitch McConnell (R-Ky.) and his leadership team threw everything they had at wavering senators: the threat of political disaster if they fail, an open amendment process to allow their ideas to be debated — and the argument that a flawed Senate bill can be fixed later in conference negotiations with the House.

President Donald Trump called the Senate vote to proceed to an ACA repeal bill a “big step” and reprimanded Democrats for voting in lockstep against the motion to proceed.