WASHINGTON (NBC) — Senate Republicans were dealt a blow late Tuesday night when a bill to repeal major parts of the Affordable Care Act failed.

Just 43 Senators voted for the bill, well short of the 60 required votes to overcome a parliamentary objection.

Nine Republicans voted against the bill, which called for severe cuts to the Medicaid program.

It also included cuts to Obamacare subsidies that help lower income people pay for the cost of health insurance.

This was the first of several expected votes this week which would repeal or replace parts of former President Obama’s health care law. </s> WASHINGTON - The Senate voted Wednesday to defeat a bill that would have repealed Obamacare within two years without any immediate plan to replace the sweeping health care law.

Senators voted 45-55 in favor of the bill, falling six votes short of the 51 needed to pass it. Seven Republicans voted against it: John McCain of Arizona, Dean Heller of Nevada, Susan Collins of Maine, Rob Portman of Ohio, Lamar Alexander of Tennessee, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia.

The vote comes on the second day of a 20-hour Senate debate on health care as Republican leaders scramble to win enough votes from their own members to pass something to replace the Affordable Care Act. The Senate began its session Wednesday morning with about 17 hours left in the debate.

Here's a look at where things stand now:

What are they voting on today?

The big vote so far was the failed attempt to pass the amendment by Sen. Rand Paul, R-Ky., to repeal the Affordable Care Act within two years, which would have given lawmakers time to come up with a replacement plan before the law expired. The proposal is the same as one passed by Congress in 2015, which was vetoed by former president Barack Obama. Collins is the only Republican senator who voted against the bill both times.

With a Republican president in the White House, GOP leaders tried again. Paul and other conservatives have led the push for a complete repeal of Obamacare. But there has been a lot of hesitation among Republicans for "repeal" without a plan for "replace."

What have they already voted on?

On Tuesday, senators voted 50-50 to begin debate on a health care bill. Vice President Pence had to come to the Senate chamber to break the tie and allow debate to start.

After that, the biggest news came Tuesday night when senators defeated a Republican bill, on a vote of 43-57, to replace Obamacare. Nine Republican senators voted against the legislation, which was drafted by Senate Republican leaders.

It included a proposal by Sen. Ted Cruz, R-Texas, to allow insurers to sell bare-bones health care plans that don't cover maternity care and other major benefits as long as the companies also sell plans that include a full range of benefits.

The defeated plan also included a proposal by Sen. Rob Portman, R-Ohio, to provide $100 billion in aid to help low-income Americans pay their medical bills after they lose Medicaid coverage as a result of the Senate health care bill.

What are Democrats doing?

The Democrats have been voting against the Republican bills to repeal and replace Obamacare. They also are using procedural tactics to try to slow down the debate process.

For example, Sen. Joe Donnelly, D-Ind., will offer a motion Wednesday to send health care legislation back to the Finance Committee for consideration. On Tuesday, they objected to the usual Senate practice of waiving the reading of the bill, so Senate clerks had to spend several hours reading the leadership replacement bill aloud.

What happens after the 20 hours of debate are over?

A vote-a-rama will begin on dozens of amendments offered by senators of both parties. That is expected to start Thursday.

Do Republican Senate leaders have an endgame?

With the defeat of the comprehensive replacement bill and the "clean" repeal bill, GOP leaders are now looking to pass a "skinny repeal" bill that would make limited changes to Obamacare. It would likely strip out the law's tax on medical devices and its requirements for individuals to buy health insurance and large employers to provide coverage for their workers.

If that plan passes the Senate, it would most likely go to a conference committee of House and Senate negotiators who would try to work out a final compromise.

Democrats say Senate leaders just want to pass anything they can take to this conference committee, where the real bill would be crafted.

"It's becoming clearer that, in the end, the majority leader might push a much scaled-back version of repeal in the hopes of passing something, so-called skinny repeal, just to get to conference," Minority Leader Chuck Schumer, D-N.Y., said in a speech on the Senate floor Wednesday. "But my colleagues, make no mistake about it, skinny repeal is equal to full repeal. It's a Trojan horse designed to get the House and Senate into conference where the hard-right flank of the Republican Caucus, the (House) Freedom Caucus, will demand full repeal or something very close to it."

Why has it been so difficult for the Senate to reach agreement?

Republican leaders have been trying to please the conservative and moderate wings of their party, and they have so far failed to win the support of both groups.

Conservatives generally want a complete repeal of Obamacare's taxes and regulations while moderates worry that ending the law's Medicaid expansion will leave struggling Americans with no way to afford medical coverage.

"Ultimately, we want to get legislation to finally end the failed Obamacare status quo through Congress and to the president’s desk for his signature," Majority Leader Mitch McConnell, R-Ky., said Wednesday in a speech on the Senate floor. "This certainly won’t be easy. Hardly anything in this process has been." </s> WASHINGTON (Reuters) - U.S. Senate Republican leaders postponed a vote on a healthcare overhaul on Tuesday after resistance from members of their own party, and President Donald Trump summoned Republican senators to the White House to urge them to break the impasse.

The delay put the future of a longtime top Republican priority in doubt amid concerns about the Senate bill from both moderate and conservative Republicans. With Democrats united in their opposition, Republicans can afford to lose only two votes among their own ranks in the Senate.

Senate Majority Leader Mitch McConnell had been pushing for a vote ahead of the July 4 recess that starts at the end of the week. The legislation would repeal major elements of Obamacare and shrink the Medicaid government healthcare program for the poor.

“We’re going to press on,” McConnell said after announcing the delay, adding that leaders would keep working to make senators “comfortable” with the bill. “We’re optimistic we’re going to get to a result that is better than the status quo.”

At the White House meeting with most of the 52 Republican senators, Trump said it was vital to reach agreement on the Senate healthcare measure because Obamacare was “melting down.”

“So we’re going to talk and we’re going to see what we can do. We’re getting very close,” Trump told the senators. But he added, “If we don’t get it done, it’s just going to be something that we’re not going to like, and that’s okay.”

McConnell, whose party has a razor-thin majority in the 100-member Senate, told reporters that Republican leaders would work through the week to win over the 50 senators needed to pass the bill, with a vote planned after the recess. Vice President Mike Pence could provide the crucial vote needed to break a tie.

Related Coverage Top Senate Republican expresses optimism on healthcare bill after Trump meeting

“I think we can get 50 votes to yes by the end of the week,” Republican Senator Roger Wicker said after the White House meeting.

REPUBLICAN OPPOSITION GROWS

The House of Representatives last month passed its own version of a healthcare bill, but the Senate bill has been criticized from both the left and the right. Moderate Republicans worried millions of people would lose their insurance. Conservatives said the bill does not do enough to erase Obamacare.

The bill’s prospects were not helped by a Congressional Budget Office analysis on Monday saying it would cause 22 million Americans to lose insurance over the next decade, although it would reduce the federal deficit by $321 billion over that period.

The report prompted Senator Susan Collins, a Republican moderate, to say she could not support the bill as it stands. At least four conservative Republican senators said they were still opposed after the CBO analysis.

Three more Republicans, Rob Portman of Ohio, Jerry Moran of Kansas and Shelley Moore Capito of West Virginia, said after the delay was announced that they oppose the current draft.

Portman and Capito cited the bill’s Medicaid cutbacks and how that would hurt efforts to combat the opioid epidemic that has taken a heavy toll in their states. The Medicaid program was expanded under former President Barack Obama’s signature healthcare law.

U.S. President Donald Trump meets with Senate Republicans about healthcare in the East Room of the White House in Washington, U.S., June 27, 2017. Trump is flanked by Senators Susan Collins (R-ME) and Sen. Lisa Murkowski (R-AK). REUTERS/Kevin Lamarque

“I think giving time to digest is a good thing,” Republican Senator Bob Corker said after the delay was announced.

“UNCERTAINTY” ON WALL STREET

U.S. stock prices fell, as the decision to postpone the vote added to investor worries about Trump’s ability to deliver on his promises of tax reform and deregulation, as well as changes to the health sector. Those expected changes have driven a rally in U.S. stocks this year.

The benchmark S&P; 500 index closed down 0.8 percent, and the Dow Jones industrial average finished down 0.46 percent.

“The market likes certainty and now there’s uncertainty. What is this going to look like when this gets out of the next iteration?” said Peter Costa, president of trading firm Empire Executions Inc.

Passing the measure would be a win for Trump as he seeks to shift attention after weeks of questions over Russia’s role in last year’s U.S. presidential election.

McConnell has promised since 2010 that Republicans, who view Obamacare as a costly government intrusion, would destroy the law “root and branch” if they controlled Congress and the White House. Republicans worry a failure to deliver will cost them votes in next year’s congressional elections.

If the Senate passes a healthcare bill, it will either have to be approved by the House or the two chambers would reconcile the differences in a conference committee. Otherwise, the House could pass a new version and send it back to the Senate.

Slideshow (12 Images)

Lawmakers are expected to leave town by Friday for their July 4 holiday break, which runs all next week. The Senate returns to work on July 10, the House on July 11. Lawmakers then have three weeks in session before their month-long August recess.

(This story corrects Dow Jones industrial average’s percent loss in 16th paragraph.) </s> WASHINGTON — Republicans narrowly advanced their campaign to roll back the Affordable Care Act on Tuesday, as the Senate voted by a slim margin to begin debating legislation to repeal and potentially replace large sections of the 2010 law signed by President Barack Obama.

But the partisan 51-50 vote — with Vice President Mike Pence breaking a tie — does not assure the success of the GOP’s seven-year quest to dismantle the sweeping law, often called Obamacare.

With health coverage for tens of millions of Americans at stake, it remained unclear Tuesday what kind of health care bill — if any — might emerge by the time a final Senate vote is held, possibly as early as Thursday.

Senate Majority Leader Mitch McConnell, R-Kentucky, has set up a series of votes this week on competing proposals to repeal much of Obamacare, or repeal and replace pieces of the law.

Tuesday’s procedural vote to kick off that process marks a victory for McConnell, who has been laboring for months behind closed doors to rally his divided caucus, and for President Donald Trump, who has been publicly calling out GOP senators to stick with the repeal push.

But to get to the vote, McConnell abandoned customary legislative process, foregoing public hearings and committee debate in a way almost never seen for major legislative proposals.

And he left Republican lawmakers with a series of legislative options — which polls show are also deeply unpopular with Americans — that would leave as many as 32 million more people without health coverage and weaken health protections for tens of millions more.

The GOP plans have been widely panned by independent analysts and vigorously opposed by every major patient advocacy group and every leading organization representing physicians, nurses and hospitals.

Opponents include the American Diabetes Association, the March of Dimes, the AARP, the American Medical Association, the American Lung Association, the National Multiple Sclerosis Society, the American Heart Association and the advocacy arm of the American Cancer Society.

Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted against the motion.

Collins posted on Twitter on Tuesday afternoon that she voted against the motion to proceed with debate on the bill because “when dealing w/ a complex issue that affects millions of Americans & ⅙th of our economy, we must proceed carefully.”

“Making sweeping changes to the 50-year-old Medicaid program without a single Senate hearing is a mistake,” she tweeted. “We must work in a bipartisan way to to fix the ACA’s serious flaws.”

In a statement Tuesday, Maine’s junior senator, independent Angus King, called the legislation “misguided,” adding that any version of the bill “will hurt millions of people across the country and tens of thousands of hardworking people across Maine.”

“I’ve never seen a process like this before with no hearings and it will almost certainly produce a terrible bill that will drastically raise costs for people in Maine, put coverage out of reach for many others, and reduce Medicaid funding, causing states to choose between helping seniors or children or people with disabilities,” King said. “As the Senate advances with this bill, I will continue to support and protect people in Maine and work to find solutions that keep people covered and make health care more affordable.”

GOP leaders were aided by the dramatic return to the Capitol by Sen. John McCain, R-Arizona, after surgery last week and a diagnosis of brain cancer. He arrived in the chamber to cheers and a standing ovation from his colleagues.

As Republicans next move to crafting a final bill, one leading GOP option, favored by conservatives, is to simply repeal most major parts of Obamacare, and then try to pass a new health care law in the future.

Another idea, supported at one point by GOP leaders, would replace most of the law while at the same time dramatically scaling back federal funding of the Medicaid insurance program that covers some 74 million low-income, elderly and disabled Americans.

GOP centrists have complained both of those versions would leave too many Americans without insurance, and have urged McConnell to start the process over, working on a bipartisan approach that will protect those covered under Obamacare.

So far, none of these approaches has garnered the necessary 50 votes from the Republicans’ 52-seat Senate majority.

The lack of GOP consensus prompted Senate Republican leaders to float a new idea Tuesday — a far more limited repeal bill that would target the most unpopular parts of Obamacare, including its insurance mandates.

That plan — dubbed “skinny repeal” — would eliminate only a medical device tax established by Obamacare and two mandates requiring Americans to have coverage and requiring large employers to offer health benefits.

The approach would fall far short of what Republicans have been promising for years.

If it passes, Senate Republicans could at least send something to a conference committee where lawmakers could work out a compromise with a sweeping repeal bill passed by House Republicans in May, giving them yet another shot at unwinding Obamacare.

That would all have to be done without Democrats, who remain fiercely opposed to the GOP repeal push and voted together Tuesday to try to block the beginning of Senate debate.

The skinny repeal plan risks major disruptions to the nation’s insurance markets, as the lack of any insurance mandate could free Americans to buy health insurance only when they get sick, driving up costs.

But it would leave in place other critical parts of the 2010 law, including hundreds of billions of dollars of federal aid to state Medicaid programs and insurance subsidies that help low- and moderate-income Americans

That assistance is credited with helping extend coverage to more than 20 million previously uninsured Americans.

Also untouched would be landmark rules established by Obamacare that require insurers to cover a basic set of benefits and prohibits health plans from discriminating against Americans with preexisting medical conditions.

It remains unclear whether House Republicans would agree to this more limited repeal plan.

But with centrist and conservative GOP senators in deep disagreement, the skinny repeal may be all McConnell can pass.

The repeal-only plan — which is favored by the most conservative GOP senators — would leave an estimated 32 million more people without health coverage over the next decade, according to the nonpartisan Congressional Budget Office, or CBO.

It is opposed by multiple centrist GOP senators.

The alternative proposed by McConnell that repeals and replaces major parts of the law while also dramatically scaling back federal Medicaid assistance is only slightly less disruptive, CBO analysts have concluded.

The McConnell proposal, which has drawn fire from both centrist and conservative Republicans, would leave 22 million more Americans without insurance by 2026.

That plan would be most devastating to the Medicaid safety net, which currently covers some 70 million poor Americans, including children. Federal Medicaid funding would be reduced by more than a third over the next two decades.

And while CBO concluded the “repeal-and-replace” plan could lower premiums for some consumers, it would likely put health insurance out of reach for older and sicker Americans who could be forced to pay larger deductibles or higher premiums than under the current law.

Still unclear is the effect of yet other GOP proposals that could come up for votes in coming days, including one by Sen. Ted Cruz, R-Texas, to allow health insurers to sell skimpier plans that do not include basic benefits such as prescription drugs, maternity care and mental health and substance abuse services.

The Cruz proposal is widely expected to make health coverage more expensive for sick Americans who need to buy more extensive health coverage and has been panned by health insurers as “unworkable.”

But McConnell elected to proceed with voting Tuesday before CBO had an opportunity to assess the potential impact of Cruz’s proposal. </s> WASHINGTON, D.C. (CBS) — The Senate voted Tuesday in favor on a motion to proceed with debate on the Senate’s health care plan to effectively repeal and replace the Affordable Care Act. On Tuesday night, the Senate Republican plan to repeal and replace the health care law failed on a procedural vote.

The Senate adjourned but will return on Wednesday morning at 9:30 a.m. to resume debate and consideration of amendments to the Republican health care bill. The next series of votes is expected at 11:30 a.m. Eastern.
• After 50 “no” votes on the motion to proceed to debate (including all Democrats plus two Republicans) and 50 “yes” votes from Republicans, Vice President Mike Pence broke the tie
• Sen. John McCain was welcomed back to Senate with standing ovation, votes “yes”
• Senate GOP’s plan to repeal and replace Obamacare, known as BCRA, fails in procedural vote, at about 9:30 p.m.

The first vote was intended to open debate on the American Health Care Act (AHCA), the GOP-sponsored Obamacare replacement plan that passed the House of Representatives in May.

Numerous amendments will now be offered that will dramatically change the nature of the House-passed legislation. Some amendments include a proposal to repeal and replace Obamacare, while another could simply repeal the 2010 health care law in its entirety and provide Congress with two years to figure out a replacement health care plan.

President Donald Trump has publicly pressured Republicans to vote to proceed and find a way to replace Obamacare.

Read this story on the CBS News website for the full list of Tuesday updates while Senate was in session. </s> WASHINGTON: Republican senators tried to gather more support on Monday for a last-ditch attempt to repeal Obamacare by revising funding provisions of their bill to make it more attractive to a handful of undecided lawmakers.

The outcome remained in doubt, with several senators in the party voicing concerns in recent days about the legislation to dismantle Democratic former President Barack Obama's signature healthcare law.

Republican senators leading the effort on Monday released a revised version of their bill in hopes of finding more support.

The Senate is up against a Saturday deadline for deciding the fate of the 2010 Affordable Care Act, as it is known formally. That is the day for expiration of a rule that would let the latest Republican plan pass with just a 51-vote majority, instead of the more usual 60 votes. Republicans, who control the Senate 52-48, were finding it difficult even to clear that lower hurdle.

A total of three Republican defections would kill off the latest anti-Obamacare effort and Republican Senators John McCain and Rand Paul already have registered their opposition. Others senators such as Ted Cruz, Susan Collins and Lisa Murkowski have voiced reservations.

A spokesman for Paul said on Monday the senator still opposes the latest version despite the tweaks.

The revised bill released on Monday included a table that said some states where senators have been undecided, such as Alaska and Maine, would get more money under the bill than under current law. The Washington Post first reported the revision.

For seven years, Republicans have hammered Obamacare, which extended health insurance to some 20 million Americans, as an unwarranted and costly government intrusion into healthcare, while also opposing taxes it imposed on the wealthy.

Republican President Donald Trump made repealing Obamacare one of his top campaign promises in 2016. Democrats have fiercely defended it.

Democratic leaders roundly rejected the revised draft of the repeal legislation as a sleight of hand to gain support.

The last attempt to repeal Obamacare fell one vote short in July, in a humiliating setback for Trump and Senate Majority Leader Mitch McConnell.

The new bill, originally introduced by Senators Lindsey Graham and Bill Cassidy, would take federal money spent on the Medicaid program for the poor and disabled, as well as subsidies to help Americans buy private insurance, and divvy it up to the states in block grants. Advocates say that would give states more discretion to manage their own healthcare schemes.

Opponents fear undoing Obamacare will mean millions lose healthcare, including some with pre-existing medical conditions.

U.S. hospital stocks were down across the board, in broadly bearish trading marketwide. Shares of HCA Healthcare Inc and Tenet Healthcare Corp were hit particularly hard, falling 2.8 percent and 5 percent, respectively, in afternoon trading.

"The Graham-Cassidy bill is looking to reduce funding for Medicaid in the longer term," said Jefferies analyst Brian Tanquilut. "That is a benefit that we have seen improve the earnings outlooks for these hospitals."

He said the bill could reduce the number of insured Americans, which would hurt hospitals' bottom lines.

Paul, from Kentucky, said the Graham-Cassidy plan was still too similar to Obamacare. "My promise to the voters was to repeal Obamacare - not block grants and keep Obamacare," Paul said in a statement. Only a "significant reassessment" of the "trillion-dollar spending regime" would get his support, he said.

Cruz, a conservative speaking at an event in his home state of Texas, warned on Sunday that Trump and McConnell could not count on his vote. Cruz has pushed for greater government cost savings in healthcare.

Collins, a moderate from Maine who voted against her party's bill in July, said on CNN's "State of the Union" on Sunday that it was difficult to "envision a scenario where I would end up voting for this bill." She worried about cuts to Medicaid benefits to the poor and disabled.

Graham suggested Republicans could have another shot at repealing Obamacare, even if they do not do it this week, if Senate leadership were to attach a repeal bill to a planned tax reform package.

That package was expected to be designated in 2018 for the once-per-year procedural advantage of being handled under the Senate's 50-vote reconciliation process. Trying to combine the two would be highly unusual.

"If we fall short, then you just continue the effort in putting taxes and reconciliation together," Graham told Reuters. "I think Congress can do two things at once."

U.S. Senate Democratic leader Chuck Schumer dismissed the late effort to revise the bill and add money for a few states, calling it "just as bad for those states and the rest of the states because it still contains a massive cut to Medicaid."

The Senate Finance Committee is scheduled to hold a hearing on Monday in an attempt to build support for the bill and to tamp down Democratic criticism that the measure has not been thoroughly vetted.

The non-partisan Congressional Budget Office is expected to produce as early as Monday a preliminary analysis of the bill that would assess its impact on budget deficits.

More time is likely needed for the CBO to gauge how the bill could affect Americans' access to health insurance. </s> The Senate is expected to begin a "vote-a-rama" Thursday on legislation to repeal and replace the Affordable Care Act.

The "vote-a-rama" — which occurs after the Senate debates for 20 hours on proposed legislation — allows any senator to introduce an unlimited number of amendments that are voted on without debate.

After the comprehensive replacement bill and the "clean" repeal bill were defeated this week, GOP leaders are now looking to pass a "skinny repeal" bill that would make limited changes to the Affordable Care Act, or Obamacare.

You can watch the proceedings live in the player above. </s> Three Republican senators Tuesday effectively scuttled Senate Majority Leader Mitch McConnell's plan to repeal the Affordable Care Act without replacing it. This was hours after the Senate's bill to repeal and replace Obamacare was blocked when two more GOP senators came out in opposition to it. </s> WASHINGTON — Senate Republicans, who for seven years have promised a repeal of the Affordable Care Act, took a major step on Thursday toward that goal, unveiling a bill to make deep cuts in Medicaid and end the law’s mandate that most Americans have health insurance.

The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.

But the measure landed in rough seas ahead of a vote that Senator Mitch McConnell of Kentucky, the majority leader, wants next week. Four conservative senators, Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin, announced that they would oppose it without changes — more than enough to bring it down.

“It does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs,” the four wrote in a joint statement.
A Republican Senate bill to repeal and replace large portions of the Patient Protection and Affordable Care Act fails to win enough support to pass.