Replacing Obamacare with sweeping changes faces uphill climb

In a dramatic vote Tuesday, senators agreed to open debate on a modified health care bill. Later that evening, the Senate blocked the proposal – a signal that a new approach must be taken if any revised health care legislation is to pass.

First Look

Where the Senate Republican effort to demolish former President Barack Obama's health care law ends up is anyone's guess, but early indications are the GOP will have a hard time replacing that statute with any sweeping changes.

Senators planned to vote Wednesday on a Republican amendment repealing much of Mr. Obama's law and giving Congress two years to concoct a replacement. A combination of solid Democratic opposition and Republicans unwilling to tear down the law without a replacement in hand were expected to defeat that plan.

Late Tuesday night, the Senate voted 57 to 43 to block a wide-ranging proposal by majority leader Mitch McConnell replacing Obama's statute with a far more restrictive GOP substitute. Those voting no included nine Republicans, ranging from conservative Mike Lee of Utah to Maine moderate Susan Collins, in a roll call that raised questions about what if any reshaping of Obama's law splintered Republicans can muster votes to achieve.

The rejected amendment – the first offered to the bill – was centered on language by Senator McConnell (R) of Kentucky erasing Obama's tax penalties on people not buying insurance, cutting Medicaid and trimming its subsidies for consumers. It included a provision by Sen. Ted Cruz (R) of Texas, letting insurers sell cut-rate policies with skimpy coverage plus an additional $100 billion – sought by Midwestern moderates including Sen. Rob Portman (R) of Ohio – to help states ease out-of-pocket costs for people losing Medicaid.

GOP defectors also included Sens. Dean Heller of Nevada, who faces a tough re-election fight next year, and usually steady McConnell allies Bob Corker of Tennessee, Lindsey Graham of South Carolina, and Kansas' Jerry Moran.

Before that defeat, President Trump and McConnell snatched victory from what seemed a likely defeat and won a 51 to 50 vote to begin debating the GOP drive against Obama's Affordable Care Act, which sits atop the party's legislative priorities.

In a day of thrilling political theater, Vice President Mike Pence broke a tie roll call after Sen. John McCain (R) of Arizona returned to the Capitol from his struggle against brain cancer to help push the bill over the top. There were defections from just two of the 52 GOP senators – Maine's Susan Collins and Alaska's Lisa Murkoswki – the precise number McConnell could afford to lose and still carry the day.

All Democrats voted against dismantling the 2010 statute that looms as Obama's landmark domestic achievement.

Leaders were openly discussing a "skinny bill" repealing unpopular parts of the statute like its tax penalties on people not buying coverage – a tactic aimed chiefly at letting Senate-House bargainers seek a final compromise.

McConnell was practically zen-like in his evaluation of the next steps, saying the Senate will "let the voting take us where it will."

Asked what Republicans would do now that the dog had caught the car – an expression for someone who regrettably achieves a trying goal – Sen. Orrin Hatch (R) of Utah said, "We'll have to see if the car can survive."

Senate minority leader Chuck Schumer (D) of New York said a final bill negotiated by the two GOP-led chambers would mean "drastic cuts in Medicaid, huge tax cuts for the wealthy, no help for those with pre-existing conditions and tens of millions losing coverage."

Senators started 20 hours of debate on the bill Tuesday, though angry Democrats were burning time – not counted against that total – by requiring clerks to read amendments. At week's end, a "vote-a-rama" of rapid-fire voting on a mountain of amendments was expected before moving to final passage – of something.

"Now we're all going to sit together and we're going to try and come up with something that's really spectacular," Mr. Trump told reporters at the White House. He added, "This is the beginning of the end for the disaster known as Obamacare."

That may prove a premature statement.

Internal GOP differences remained over how starkly to repeal the law, how to reimburse states that would suffer from the bill's Medicaid cuts and whether to let insurers sell cut-rate, bare-bones coverage that falls short of the requirements.

While pressure and deal-making helped win over vacillating Republicans to begin debate, they remained fragmented over what to do next. Several pointedly left open the possibility of opposing the final bill if it didn't suit their states.

Even Senator McCain, who received a warm standing ovation and bipartisan hugs when he returned, said he'd oppose the final bill if it didn't reflect changes to help his state and lambasted the roughshod process his own party was using.

He accused party leaders of concocting a plan behind closed doors and "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. I don't think that is going to work in the end. And it probably shouldn't."