WASHINGTON — President Donald Trump praised Republicans in the Senate following a narrow vote Tuesday to begin debate on health care legislation that would repeal Obamacare.
The Senate voted 50-50, prompting Vice President Mike Pence to cast the tie-breaking vote that will allow lawmakers to begin a fast-paced process to build a bill with an open amendment process.
The vote was seen as a must-have victory for Trump, who has yet to have a major legislative accomplishment during his first six months in office.
“I applaud the Senate for taking a giant step to end the Obamacare nightmare,” Trump said. “The Senate must now pass a bill and get it to my desk so we can finally end the Obamacare disaster once and for all.”
The president has cajoled and twisted arms behind the scenes, trying to secure the votes from lawmakers whose states have varying degrees of health care needs.
Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, voted against bringing the bill to the floor for consideration. Since last week, Sen. Shelley Moore Capito, R-W.Va., was won over by GOP leaders and voted to move forward with the legislation.
Heller votes yes
Sen. Dean Heller, R-Nev., who opposed an earlier version of the Senate health care bill because of Medicaid cuts, voted with the majority to begin debate, but said he may or may not support a final bill.
Heller wants Medicaid to remain protected for the more than 200,000 Nevadans who became eligible under expansion.
Another bill by Sen. Lindsey Graham, R-S.C., and Sen. Bill Cassidy, R-La., would grant states more flexibility.
“There are commonsense solutions that could improve our health care system and today’s vote gives us the opportunity to fight for them,” Heller said.
“If the final product isn’t improved for the state of Nevada, then I will not vote for it, if it is improved, I will support it,” Heller said.
Last month, Heller stood next to Nevada Gov. Brian Sandoval at a press conference in Las Vegas where both men outlined their objections to the first draft of the Senate’s health care bill. On Tuesday, Sandoval reiterated his opposition to cuts in Medicaid.
”My policy position has not changed. I will continue to do all I can to protect the thousands of Nevadans whose lives are healthier and happier as a result of the expansion of Medicaid,” he said. “My health care team which includes staff and cabinet experts, have and will continue to review proposals offered in the Senate and discuss the potential impacts on Nevada with Senator Heller and his staff.”
Heller is considered the most vulnerable Republican senator facing reelection in 2018. A Democratic opponent, Rep. Jacky Rosen, D-Nev., accused him of “caving” to presidential pressure to move the bill to the floor.
“Senator Heller had a chance today to stop the GOP’s toxic health care agenda, but instead he broke his word and cast the deciding vote to repeal the Affordable Care Act with no replacement plan,” Rosen said.
Democrats unanimously voted against the motion to begin debate.
“This vote today is a disaster for Nevada,” said Sen. Catherine Cortez Masto, D-Nev. “It will hurt hundreds of thousands of Nevadans.”
Earlier this week, Cortez Masto disclosed a list of 183 local and national medical, health, education and faith groups opposed to Senate versions of the health care bill.
‘Here to do the big stuff’
The vote in the Senate chamber was dramatic. As Senate Majority Leader Mitch McConnell, R-Ky., ushered lawmakers into the chamber after a party luncheon, his voice rose as he prompted his Republican caucus to support the bill.
He told GOP lawmakers that constituents didn’t “send us here to do the easy stuff, they sent us here to do the big stuff.”
In the visitor gallery, about two dozen protesters stood up and tried to stop the vote, chanting: “Kill the bill, don’t kill us,” and “Shame, shame, shame.”
The vote was held open until Sen. John McCain, R-Ariz., recuperating from aggressive brain cancer, entered the chamber to applause and voted to proceed to the bill.
McCain, 80, gave an impassioned speech for lawmakers to work across partisan lines and craft a health care solution that may not please ideologues on either side, but would serve those who rely on the care.
He had the rapt attention of everyone in the chamber, Republicans and Democrats.
“Stop listening to bombastic loudmouths on the radio,” McCain said to cheers.
McCain said much work remains on the legislation. “I will not vote for this bill as it stands today.”
The veteran lawmaker implored his colleagues to work together. “Something has to be done,” he said to a standing ovation.
Votes begin on amendments
“We were all glad to see our old friend John McCain,” said Sen. John Cornyn, R-Texas. “I thought he delivered a very important message and at a very timely basis because this legislation is open for amendment not just by Republicans, but by Democrats as well.”
The Senate began voting late Tuesday on amendments to the bill. A proposal by Sen. Ted Cruz, R-Texas, and Sen. Rob Portman, R-Ohio, to help low-income people move off Medicaid and on to insurance plans was defeated because the measure did not include an analysis by the nonpartisan Congressional Budget Office.
Heller voted no.
“This amendment jeopardizes too many Nevadans’ health care coverage so I cannot support it,” he said. There is, however, a way forward if states like Nevada are given the flexibility to build on their successes and ensure protection for those who are currently covered.”
Amendments to the bill will continue through the night.
Any differences between the Senate and House legislation must then be ironed out in a conference committee.
Centrists senators have balked at efforts to cut $756 billion out of Medicaid spending, and the end to expansion of Medicaid, which allowed 31 states including Nevada to reduce their rates of uninsured.
Conservatives, however, have bristled at the mandates in the ACA that require people to buy insurance, the expansion of Medicaid, and taxes on the more affluent to provide subsidies for low-income patients.
Contact Gary Martin at 202-662-7390 or firstname.lastname@example.org. Follow @garymartindc on Twitter.