Obamacare repeal battle back on the Senate floor

WASHINGTON (Reuters) - After a months-long struggle, Republicans have succeeded in bringing Obamacare repeal legislation, a centerpiece of their 2016 election campaigns, to a debate on the U.S. Senate floor. Now the hard part begins.

Republicans, deeply divided over the proper role of the government in helping low-income people receive healthcare, eked out a procedural win on Tuesday when the Senate voted 51-50, with Vice President Mike Pence breaking a tie, to allow debate to start on legislation.

The outcome came as a huge relief to President Donald Trump, who has called Obamacare a "disaster" and pushed fellow Republicans in recent days to follow through on the party's seven-year quest to roll back the law.

But hours later, Senate Republican leadership suffered a setback when the repeal-and-replace plan that they had been working on since May failed to get enough votes for approval, with nine out of 52 Republicans voting against it.

Usually, bills reach the floor with a predictable outcome: Senators have received summaries of the legislation to be debated that were written in an open committee process, leaders have counted the number of supporters and opponents, amendments are debated and everybody knows the likely outcome: passage.

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All that is out the window now, as the Republican-led Senate on Wednesday continues a freewheeling debate that could stretch through the week on undoing major portions of Democratic President Barack Obama's 2010 framework, which expanded health insurance to about 20 million people, many of them low-income.

More votes were expected at around 11:30 a.m. (1530 GMT), as Senate Majority Leader Mitch McConnell exhorted senators to bring amendments to the floor. Senate Democratic leader Chuck Schumer urged the Senate to scrap the entire exercise and move to bipartisan discussions on improving Obamacare.

"Ultimately we want to get legislation to finally end the failed Obamacare legislation through Congress and to the president's desk for his signature," McConnell said, while noting the difficulties ahead.

U.S. Health and Human Services Secretary Tom Price told CNBC in an interview on Wednesday that Senate Republicans should aim for the "lowest common denominator" in order to get the 50 votes needed to pass a bill.

Republican leaders have insisted they can devise a cheaper approach this week and with less government intrusion into consumers' healthcare decisions than Obamacare, formally known as the Affordable Care Act.

Democrats and other critics of the Republican effort said it would deprive millions of health coverage.

"We've tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then 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," Republican Senator John McCain said on the Senate floor on Tuesday.

"I don't think that is going to work in the end. And it probably shouldn't," he added in dramatic remarks after returning from surgery and being diagnosed with brain cancer.

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McCain appealed to McConnell to start over by having a Senate committee, in a bipartisan way, craft new healthcare legislation.

His proposal was ignored.

'Skinny' Bill Gets Traction

As senators grind through potentially scores of amendments in coming days - in a process called a "vote-a-rama" - they will have to worry about more than scorn from McCain, who did back the second vote on Republican's repeal and replace plan.

Trump attacked opposing members from his own party, targeting Lisa Murkowski by name in an early morning tweet on Wednesday. Aides to the senator from Alaska did not immediately respond to a request for comment.

The other opposing Republicans in Tuesday's second vote included Senators Susan Collins, Bob Corker, Tom Cotton, Lindsey Graham, Dean Heller, Mike Lee, Jerry Moran and Rand Paul.

Healthcare industry organizations are also similarly troubled and have urged a more bipartisan effort.

The Republican drive to repeal and replace Obamacare has taken many unexpected turns since the House of Representatives began working on its version of legislation in March.

For now, many Republican senators are wondering whether they may end up going to a Plan B - a "skinny" healthcare bill that would simply end Obamacare's penalties for individuals and employers that do not obtain or provide health insurance, as well as abolish a medical device tax.

It would then be up to a special Senate-House committee to finalize a bill that could still change during negotiations. If that effort succeeded, the full House and Senate would again have to approve the legislation.

While it remained to be seen what the final legislation will look like, the possible components of the bill were clear.

After Tuesday's nail-biter Senate vote setting up the floor debate, McConnell may have best summed up the landscape facing the chamber's 100 senators.

"This is just the beginning," he told reporters.