WASHINGTON (NYTIMES) - The Senate voted narrowly on Tuesday to begin debate on a Bill to repeal major provisions of the Affordable Care Act, but hours later, Republican leaders suffered a setback when their most comprehensive plan to replace former President Barack Obama's health law fell far short of the votes it needed.
The Tuesday night tally needed to reach 60 votes to overcome a parliamentary objection. Instead, it fell 43-57. That the comprehensive replacement plan came up well short of even 50 votes was an ominous sign for Republican leaders still grappling with a formula to pass final health care legislation this week.
For Republicans, the failure ended the day on a sour note, hours after a more triumphant scene in the well of the Senate. Lawmakers from both parties had risen to their feet in the afternoon and applauded when Senator John McCain showed up in the chamber despite his diagnosis of brain cancer. He cast a crucial vote in favour of opening what promises to be a freewheeling, hard-fought debate over the future of the Affordable Care Act.
The 51-50 vote to start debate, with Vice-President Mike Pence breaking a tie, came only a week after the Republican effort to dismantle a pillar of Mr Obama's legacy appeared all but doomed. It provided an initial win for President Donald Trump, who pushed, cajoled and threatened senators in recent days to at least begin debating the repeal of the healthcare law.
The Tuesday night vote was on a comprehensive amendment that included disparate proposals calculated to appeal to conservatives and moderates in the Republican caucus.
One proposal, offered by Senator Ted Cruz, would have allowed insurers to sell stripped-down health plans, without maternity care or other benefits required by the Affordable Care Act, if they also sold plans that included such benefits.
The amendment also included money to help pay out-of-pocket medical costs for certain low-income people, including those who buy private insurance after losing Medicaid coverage as a result of the Senate bill. This proposal was devised by Senator Rob Portman and other senators from states that have expanded Medicaid under the Affordable Care Act.
But nine Republicans defected from the package, from all ends of the party's ideological spectrum.