Senate Republicans voted by the narrowest of margins – 51-50 – to begin debate to repeal and replace the Affordable Care Act. Several days ago even this procedural victory appeared unlikely.
McConnell scheduled today’s vote even though several polls show the bill’s low public approval. With the help of President Donald Trump, McConnell pressured just enough senators to vote in favor of the motion – including Dean Heller and Rand Paul – who previously said they had concerns with Republican reform ideas.
Although McConnell and Trump successfully used their positions to pressure critics such as Ron Johnson of Wisconsin, one of the most vocal critics of the process used in the Senate, it is unlikely the tactics used to squeeze 50 Republican senators to vote to allow debate will translate into a Republican bill that repeals and replaces Obamacare.
The likely leaders in the next phase of the Republican attempts to reform health care will come from different parts of the caucus. Their arguments in the upcoming debates will be forceful and not amenable to the pressures of McConnell or Trump.
Susan Collins of Maine, one of two Republicans who voted against the motion to debate, leads the group of moderate Republicans and has been clearest about the need for starting over on reform.
McCain made an emotional return to the Senate floor to cast his vote to proceed with debate, even while criticizing the Republicans’ bill and the process used by McConnell. McCain represents the mainstream Republicans who want to follow a more traditional legislative process.
Rand Paul of Kentucky, speaking for the libertarian wing, argues that nothing short of a complete repeal of the ACA with no reform that offers government subsidies is the best solution.
The Republican caucus remains divided about the way forward on health care reform. However, with a weakened majority leader and an unpopular president, it will be interesting to see who emerges as a leader in the next few weeks.