Sen. John McCain, the maverick of the U.S. Senate, who just days ago underwent surgery to begin his battle with an aggressive form of brain cancer, strode onto the Senate floor to cast the decisive vote on the motion to proceed on the Republican health care bill. Elise Viebeck paints the scene for the Washington Post:
As they do for every senator, high-school-age pages opened the Senate chamber’s doors, and McCain walked through. But unlike what they do for every other senator, his colleagues turned in his direction and broke into applause.
McCain entered to a rousing ovation. He waved his arms at the clerks who record votes, and after they called his name, he flashed a thumbs-up to vote yes. Johnson immediately went to the well and also flashed a thumbs-up, providing the crucial 50th vote to allow Pence to break the tie.
This is just the first procedural step in a precarious and winding path toward repeal of Obamacare, but it was a crucial one. From a messaging standpoint, it reiterates to the American voters that Republicans are serious about addressing the fundamental failures of Obamacare, failures that have resulted in dramatically higher prices and perilously few choices on the exchanges.
“I’d like to reiterate what the president said yesterday,” Senate Majority Leader Mitch McConnell told the Senate. “‘Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare.’ That’s a position that even Democrats have found hard to defend.”
The vote was also procedurally imperative. It allows the Senate to move to 20 hours of debate, after which time the Senate will proceed with a “vote-a-rama,” a process that allows for germane amendments to be offered by both parties, as well as a final vote on the legislation.
The goal now is deceptively simple.
“Whatever gets to 50,” Sen. John Thune (R-S.D.) said following the vote.
“There’s a lot of work ahead of us and I don’t think anybody’s taking anything for granted,” he continued. “If we can get something by the end of this week through the Senate it would at least position us so that we can get to conference with the House.”
There’s no guarantee that Sen. McConnell can get there. All 48 Democrats will vote “no,” regardless of the substantive merits of the bill for no other reason than they believe that anything opposing President Trump is politically beneficial for them. And that leaves little margin for error among Republicans.
Inevitably, it will be an incredibly challenging few days for Sen. McConnell who must attempt to find a throughline between those in the caucus who felt that the “Better Care Reconciliation Act” didn’t go far enough in dismantling the Obamacare system, and those in the caucus who were concerned that it went too far, particularly in the legislation’s changes to Medicaid.
That may come in the form of a so-called “skinny repeal” provision that would eliminate the individual and employer mandates as well as the tax on medical device makers. That approach would focus on the pieces of repeal that all Republicans agree with in order to craft a more comprehensive reform approach in conference with the House of Representatives
“I’ve always said I will vote for any permutation of repeal. Obviously I want as much as I can get but I’ll vote for whatever the consensus can be. It’s what I’ve been saying for months: Start on what you can agree on,” Paul (R-Ky.) said in an interview on Wednesday. “Starting small and getting bigger is a good strategy.”
Regardless of what happens over the next several hours and days, the vote on the motion to proceed sent a powerful signal that finding a majority to agree on a replacement is possible. Not just possible, but imperative.
“One thing we know is that we have to get to a result and a result that repeals as much of Obamacare as we possibly can because Obamacare is in a death spiral,” Sen. Thune said. “It’s leading to skyrocketing premiums and collapsing markets. All you have to do is look at the numbers and its clear that this is a disaster we have to save the American people from.”