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.

Thirty years before Republican lawmakers imperilled President Donald Trump’s hopes of uprooting Obamacare, the property mogul penned some negotiating tips in The Art of The Deal. “The worst thing you can possibly do in a deal is seem desperate to make it,” he wrote.

In a week when his party’s inability to repeal and replace his predecessor’s health programme bordered on farce, Mr Trump has appeared to be following that tip. “Let Obamacare fail, it will be a lot easier,” he said, suggesting that if there was to be no deal on an orderly overhaul of the system, it should be left to collapse on its own.

With disarray over healthcare ranking among the ignominies of the president’s first six months in office, the let-it-fail mantra injected a fresh dose of chaos and confusion and drew accusations of callousness. Next week the Senate may attempt another vote on Obamacare, also known as the Affordable Care Act, but whether it will be repeal-only, repeal-and-replace or something else remains undecided.

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