The U.S. Senate will debate a bill to repeal the Patient Protection and Affordable Care Act.

  • Vote to repeal Affordable Care Act expected Tuesday afternoon
  • GOP may not have enough votes to repeal Obamacare

The vote was 50-50, and Vice President Mike Pence cast the tying vote.

Sen. Susan Collins of Maine and Sen. Lisa Murkowski of Alaska broke with fellow Republicans to vote against allowing debate.

While there are enough votes for the debate, it's still not clear if there will be enough votes to repeal the bill.

It's still also not clear whether they are repealing ObamaCare, or repealing and replacing it. They will be debating the House version of the bill, the American Healthcare Act, but the bill will likely not make it out of the Senate as is, if at all.

The Senate's vote included Sen. John McCain, R-Arizona, returning to the Senate for the first time since surgery revealed he had brain cancer. McCain voted to move forward with debate.

However, McCain said he would not vote for the bill as it currently is and said it needed to be changed. 

He also excoriated the Republican leadership and the Trump Administration for not including Democrats in the process of creating a bill to repeal the ACA. He implored the Senate to go back to the "old way of legislating" by creating a bill through committee with contributions on both sides.

"What have we to lose by trying to work together to find those solutions?" McCain asked. "We're not getting done much apart."

McCain is returning to Washington just a week after the announcement that he had an aggressive form of brain cancer.

No stranger to heroic episodes, the Navy pilot who persevered through five years of captivity during the Vietnam War announced through his office that he would be back in Washington for the critical roll call on beginning debate on the legislation. The 80-year-old senator has been at home in Arizona since he revealed last week that he’s undergoing treatment for brain cancer, but a one-sentence statement said he “looks forward” to returning for work on health care and other legislation.

The president is glad that McCain is coming back.

McCain returning to the Senate is something that he is looking forward, the senator tweeted.

McCain comes at a critical time for Republican leaders. After postponing a vote twice because there was not enough support, senators on Tuesday will be asked to vote to open up debate on repealing and replacing the Affordable Care Act.

"The only way we'll have an opportunity to consider ideas is if senators are allowed to offer and debate them,” said Senate Majority Leader Mitch McConnell. “That means voting to begin the open amendment process. That means voting to kick off a robust debate in which senators from all parties can represent the views of their constituents.”

However, Democrats say they do not know what version of the health care bill they will be debating.

“I don't know how a single one of my Republican friends can, in good conscience, vote to proceed to a truncated debate on something as important as health care without knowing what bill they're ultimately voting on," said Senate Minority Leader Chuck Schumer.

The vote means 20 hours of debate and countless amendments in a battle likely to last all week. Moderate and conservative Republicans would try reshaping the bill in their direction while Democrats would attempt to force GOP senators to cast difficult votes aimed at haunting them in re-election campaigns.

Even then, the measure’s ultimate fate still seemed iffy because of GOP divisions. Obama’s law was enacted in 2010 over unanimous Republican opposition. Since then, its expansion of Medicaid and creation of federal insurance marketplaces has produced 20 million fewer uninsured people. It’s also provided protections that require insurers to provide robust coverage to all, cap consumers’ annual and lifetime expenditures and ensure that people with serious medical conditions pay the same premiums as the healthy.

Those divides sharpened with Trump willing to sign legislation and estimates by the nonpartisan Congressional Budget Office that several GOP bills would cause more than 20 million people to become uninsured by 2026. Polls showing growing popularity for Obama’s law and abysmal approval ratings for the GOP effort have not helped.

The House approved its version of the bill in May after several setbacks. It is similar to the Senate measure McConnell unveiled in June after writing it privately. But he is also revised it in his hunt for GOP votes.

McConnell’s bill would abolish much of Obama’s law, eliminating its tax penalties on people not buying policies, cutting Medicaid, eliminating its tax boosts on medical companies and providing less generous health care subsidies for consumers.

Moderate Sen. Susan Collins, R-Maine, has remained opposed to beginning debate on any option McConnell has revealed so far. Conservative Sen. Rand Paul, R-Ky., said he would vote no unless leaders agreed to an early vote on simply repealing Obama’s statute and giving Congress two years to replace it.

Conservatives were seeking language letting insurers offer bare-bones policies with low premiums, which would be illegal under Obama’s law. Moderates from states whose low-income residents rely heavily on Medicaid were resisting the GOP bill’s cuts in that program.


The Associated Press contributed to this story.