The Senate voted Tuesday to begin debate on the plan to repeal Obamacare outright and replace it within two years — after Vice President Mike Pence voted to break a 50-50 tie and an ailing Arizona Sen. John McCain returned to slam the chamber's secretive process.
"On this vote, the yeas are 50 and the nays are 50," Pence said. "The Senate being equally divided, the vice president votes in the affirmative and the motion is agreed to."
Moderate Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted against the motion, which Senate Majority Leader Mitch McConnell of Kentucky proposed after two previous versions of a healthcare bill failed to attract enough votes.
Several senators switched their positions after saying as recently as last week that they would not support a complete Obamacare repeal without replacement.
They were Sens. Shelly Moore Capito of West Virginia, Ron Johnson of Wisconsin, Rob Portman of Ohio and Dean Heller of Nevada – considered the party's most vulnerable incumbent going into next year's congressional elections.
McCain, 80, who was diagnosed with brain cancer after undergoing surgery 11 days ago, returned to the Senate to vote for the procedural motion.
He was the first to speak on the floor during debate.
"I voted for the motion to proceed to allow debate to continue and amendments be offered," McCain said. "I will not vote for this bill as it is today.
"It's a shell of a bill right now. We all know that."
He called for both parties to work together to bring forth legislation that would improve healthcare for all Americans.
"We keep trying to win without help from the other side of the aisle," McCain said. "We are getting nothing done, my friends, we're getting nothing done.
"All we've managed to do was make more popular a policy that wasn't very popular," he said, referring to Obamacare.
"The administration and congressional Democrats shouldn't have forced through Congress without any opposition a program that brought forth social and economic change as massive as Obamacare.
"And we shouldn't do the same with ours.
"If this process ends in failure, which seems likely, then let's return to regular order," McCain said.
"What a great honor, an extraordinary opportunity it is to serve in this body," he concluded. "It's a privilege to serve with all of you. I mean it.
"I hope to impress on you again that it is an honor to serve the American people in your company."
McCain's comments were greeted with a standing ovation.
President Donald Trump afterward thanked McCain for coming from Arizona to cast his vote to move the healthcare motion forward, calling him a "very brave man."
"He made a tough trip to get here and vote," Trump said at the start of a joint news conference with Lebanese Prime Minister Saad Hariri in the White House Rose Garden. "We want to thank Sen. McCain and all of the Republicans.
"We passed it without one Democrat vote," the president added. "And that's a shame, but that's the way it is. And it's very unfortunate.
"But I want to congratulate the American people, because we're going give you great healthcare."
The Senate last voted to repeal Obamacare in 2015, but it was vetoed by then-President Barack Obama. The House has voted more than 50 times to end the healthcare program.
President Trump has vowed to sign any bill that repeals the Affordable Care Act.
Before the procedural vote, McConnell encouraged Republicans to take action to end Obamacare after promising to do so for seven years.
"We have a duty to act," he said. "The president's ready with his pen.
"The House has passed legislation. Today, it's the Senate's turn.
"That starts with a vote we'll take momentarily. The critical first step in that process, the motion to proceed.
"It's the vote that determines whether this debate can proceed at all," McConnell said. "Whether we'll even take it up."
But Minority Leader Chuck Schumer pleaded with Republicans to reject the procedural vote and work with his party – saying that beginning debate on the repeal motion would eventually lead to the end of Obamacare.
"The best the majority leader's been able to cook up is a vague plan to do whatever it takes to pass something — anything — to get the bill to a House and Senate conference on healthcare," the New York Democrat said before McConnell spoke.
"My colleagues, plain and simple, it's a ruse," Schumer continued. "The likeliest result of a conference between the House and Senate is full repeal of the Affordable Care Act or something very close to it."
He slammed Republicans for crafting the healthcare plan under "much cloak-and-dagger legislating" and for locking Democrats out of the process.
"Their plan all along was to keep their bill hidden for as long as possible, evade scrutiny, hide the truth from the American people, and then jam the bill through in the dead of night on a party line," Schumer said.
McConnell emphasized that the motion opens the debate on repealing Obamacare – and that any legislation could be amended during the debate process.
"President Obama vetoed what we passed before," he said. "President Trump will sign what Congress passes this time.
"All we have to do today is to have the courage to begin the debate with an open amendment process and let the voting take us where it will."
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