Louisiana Republican John Kennedy cracked to Politico this week that “the sight of the gallows focuses the mind,” and perhaps that explains why after months of group therapy Senate Republicans finally voted Tuesday to open debate on repealing ObamaCare. Whatever the impetus, the vote kept GOP reform hopes alive and may have saved the GOP Congress.

The 51-50 vote—with Vice President Mike Pence breaking the tie—was as close as it gets but vindicates Majority Leader Mitch McConnell’s decision to force Senators to be accountable. Maine Senator Susan Collins’s defection was expected, and at least she was consistent with her opposition to repeal in 2015.

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The Senate on Wednesday rejected a measure that would have repealed major parts of the Affordable Care Act but would not have provided a replacement, signaling that the “clean repeal” bill that conservatives have embraced cannot get through Congress.

The vote, 45-55, underscored the bind that Republican leaders have found themselves in. Seven Republicans voted against the measure — Senators Shelley Moore Capito of West Virginia, Susan Collins of Maine, Dean Heller of Nevada, John McCain of Arizona, Rob Portman of Ohio, Lamar Alexander of Tennessee and Lisa Murkowski of Alaska — showing that repealing the health law without an immediate replacement lacks crucial support among Republicans.

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Portions of the Republican bill to repeal and replace ObamaCare will require 60 votes for passage, the Senate parliamentarian said Tuesday evening. The parliamentarian has advised senators that two provisions could be stripped out, according to a document released Tuesday by Sen. Bernie Sanders (I-Vt.), the ranking member of the Senate Budget Committee.

The provisions in question would allow insurers to charge older people premiums up to five times as high as what they charge younger people — which AARP has called an “age tax” — and would allow small businesses to establish “association health plans” that could be sold across state lines. That aspect has been championed by Sen. Rand Paul (R-Ky.)

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All eyes are on the Senate as it debates what to do about ObamaCare. But the House has a last chance this week to abolish one of the law’s most dangerous creations: a board with sweeping, unchecked power to ration care.

The Independent Payment Advisory Board—what critics call the death panel—would be an unelected, unaccountable body with broad powers to slash Medicare plans spending. But the law contains a living will for IPAB. If the president signs a congressional resolution extinguishing the panel by Aug. 15, it will never come into existence.

The real deadline is closer, since the House plans to recess Friday and not return until Sept. 5. But if the House does act, the Senate will have time to follow, since it plans to remain in session until mid-August.

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Senate Republicans voted to advance to floor debate on their efforts to repeal and replace Obamacare.

Vice President Mike Pence cast the tiebreaking vote. In a dramatic moment, Sen. John McCain returned from Arizona to applause from fellow senators. He cast a necessary Republican vote for the motion after two GOP senators — Susan Collins and Lisa Murkowski — sided with all Democrats in opposition.
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Following a week of high-level negotiations among GOP senators, Republican leadership is planning a Tuesday vote on the motion to proceed to the House-passed American Health Care Act (AHCA) — the vehicle for their health care reform efforts. The process has been shrouded in confusion and uncertainty, as it still remains unclear what legislation Senate leaders ultimately hope to move forward. And while knowing what’s in the Senate bill may be, as Senate Whip John Cornyn said, a “luxury we don’t have,” it’s worth acknowledging that there’s still a narrow path towards passage.

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The larger stakes in the ObamaCare fight are whether Republicans can be a governing party. They can win elections but not since the early 2000s have they showed they can pass a major reform through Congress. They blew it the last time they controlled both ends of Pennsylvania Avenue in 2005-2006. They’ve already wasted six months on health care in this Congress with nothing to show but division and discord.

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On July 21, all eight former directors of the Congressional Budget Office sent a letter to Congress defending the integrity and professionalism of CBO. But even institutions with integrity can occasionally be wrong. CBO’s score of the House and Senate healthcare bills is a case in point.

The former directors did not comment on, much less defend, those specific CBO scores. They merely objected “to recent attacks on the integrity and professionalism of the agency and on the agency’s role in the legislative process.” They could not defend the scores of the Republican plans, because they, like all other Americans, cannot see the underlying models and assumptions.

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President Trump on Monday made a late-hour appeal to senators – targeting members of his own party – to move forward with debate over faltering Republican legislation to overhaul the Affordable Care Act. “Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare, which is what it is,” Trump said in an afternoon address from the White House on the eve of an anticipated Senate vote that could spell defeat of the long-sought legislation.

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The latest version of the Senate GOP’s bill to partially repeal and replace Obamacare was pronounced dead the evening of Monday, July 17, when Utah senator Mike Lee and Kansas senator Jerry Moran announced their opposition, bringing the number of “no” votes to at least four. Where do things go from here on health care? No one knows. Here are five possibilities:

2. “Repeal-and-delay.”
3. A small bill.
4. Bipartisan bailout.
5. Nothing.