Now GOP’s efforts to undo Obamacare get real

WASHINGTON - A legislative free-for-all will ensue in the Senate following Tuesday's vote to begin 20 hours of debate on repealing the Affordable Care Act, as Republicans and Democrats try to reshape legislation passed by the House.

Senate Majority Leader Mitch McConnell began the process, offering the first amendment immediately after the 51-50 tally was sealed by Vice President Mike Pence's tiebreaking vote.

His proposal would repeal the act, popularly known as Obamacare, after a two-year delay - putting lawmakers the other side of the 2018 congressional elections.

During that period, a replacement plan would presumably be passed.

McConnell's second amendment would include the Senate's updated repeal legislation, which features a measure by Sen. Ted Cruz, R-Texas, to allow insurers to sell cheaper, less-comprehensive coverage. That amendment includes a proposal that would help Medicaid expansion enrollees move into private plans.

Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., also plan to offer a proposal that would convert nearly $110 billion in federal spending for Obamacare health insurance into state innovation grants.

Another option getting some attention - if all else fails - is a 'skinny repeal,” or one that would reject only certain components of Obamacare such as individual and employer mandates.

That's just the start.

With health coverage for tens of millions of Americans at stake, what comes to a floor vote possibly as early as Thursday could look far different in structure and cost than anything senators have yet considered.

President Donald Trump, who has pushed congressional Republicans to move more quickly on his top legislative priority, applauded the Senate for clearing the hurdle and 'taking a giant step to end the Obamacare nightmare.”

'The Senate must now pass a bill and get it to my desk so we can finally end the Obamacare disaster once and for all,” he said in a statement.

That could prove challenging, however, said Julius Hobson, a policy adviser at Washington's Polsinelli law firm who served more than 13 years as lobbyist and director of congressional affairs for the American Medical Association.

He said every Republican repeal bill has called for big cuts to Medicaid, and that has been a major sticking point with GOP senators such as Rob Portman of Ohio and Shelley Moore Capito of West Virginia, even though both of them voted to begin debate.

Sen. John McCain, recently diagnosed with an aggressive form of brain cancer, was given a standing ovation upon his return to the Senate to cast a critical vote.

But the Arizona Republican blasted the way his fellow Republicans have shut Democrats out of crafting the health care legislation and called for bipartisanship.

But speaking to reporters before the vote, Dr. David O. Barbe, president of the American Medical Association, said that can only happen if Senate and House proposals to repeal Obamacare are stopped.

'Once we get these stopped, then we can start talking in a bipartisan way,” he told reporters. 'There is a lot of good policy out there on how to do a better job of delivering care in this country. There is no lack of good policy. It has been hijacked by politics.”

The politics were on full display Tuesday.

Sen. Rand Paul, R-Ky., initially was opposed the motion to open debate but ended up supporting it when he learned he could get a vote on an amendment for a straight repeal.

In the end, Sens. Susan Collins, R-Maine, and Sen. Lisa Murkowski, R-Alaska, were the only Republicans to oppose beginning debate.

The Tribune Washington Bureau contributed to this report.