The U.S. Senate is due to vote Tuesday on whether to open debate on the latest Republican initiative to overhaul the health care system put in place under former president Barack Obama.
Senate Majority Leader Mitch McConnell is leading the push to move away from the Affordable Care Act, also commonly known as Obamacare, but over the course of the past month he has been forced to take a step back when it became clear there were not enough votes to pass two different versions of the bill.
In a series of tweets Tuesday morning, U.S. President Donald Trump said the day has arrived for Republican senators to begin dismantling Obamacare, which he said is "torturing" Americans, and applauded ailing Senator John McCain for returning to Capitol Hill to cast his vote on the health care bill.
Republicans hold a 52-48 majority in the Senate. With unified Democratic opposition to repealing the ACA, Republicans can only lose two dissenting votes, with Vice President Mike Pence casting a vote in the event of a 50-50 tie.
McCain announced he would be returning to work Tuesday after a short absence during which he announced he was diagnosed with brain cancer.
What is not clear is which bill will be voted on. The House of Representatives passed its own repeal-and-replace legislation in May, a bill Trump applauded at a White House rally after its passage and then later described as "mean." He instead called for the Senate to approve legislation with more "heart."
Senator John Cornyn said Monday that Republicans will discuss the various health care bill options at a lunch Tuesday before the procedural vote.
Democratic Senator Al Franken called the lack of clarity about which bill would be considered "deeply troubling."
"This is reckless. This is irresponsible," he said. "The American people deserve better. But let's be clear. A vote for the motion to proceed is a vote to move forward with conceivably any one of these bills, and all of these bills are terrible."
President Donald Trump continued pressuring Republicans to act on an issue that was part of his campaign, saying Monday there has been "enough talk and no action."
"Any senator who votes against starting debate is telling America you are fine with the Obamacare nightmare," said Trump, who was surrounded by several families the White House referred to as "victims of Obamacare."
"For senate Republicans, this is their chance to keep their promise," the president said. "Over and over again they said, ‘Repeal and replace, repeal and replace.’ They can now keep their promise to the American people."
Trump also tore into Obama’s health care law with fresh intensity, calling it a "government takeover" of health care and "big, fat, ugly lie" that had "wreaked havoc" on American families.
"They run out and say, ‘Death! Death! Death!'" Trump said, referring to critics of the Republican health care proposals. "Well Obamacare is death. That’s the one that’s death. And besides that, it’s failing so you won’t have it anyway," Trump said.
The ACA has been in place since 2010 and national survey show Americans view it more favorably than Republican proposals to replace it.
Several Republican lawmakers, despite Trump's campaign vow to upend Obamacare, have announced their opposition to starting debate on the repeal effort, either because they contend that the changes do not go far enough to undermine the law or go too far and would curb health insurance coverage for millions of people, particularly impoverished Americans.
About 20 million people gained insurance coverage under the law, which prevented insurance companies from denying coverage to people based on pre-existing medical conditions and required insurers to include a range of medical services in their plans.
During Obama's remaining years in office, Republicans dozens of times attempted to repeal the law and once succeeded in passing repeal legislation, which Obama quickly vetoed. He told Congress that if it sent him something that improved the law or the health system, then he would support it.
The non-partisan Congressional Budget Office has concluded that if Obamacare is repealed without a replacement, 17 million Americans would lose their health insurance next year and 32 million by 2026.
Under a Senate Republican repeal-and-replace proposal, the CBO said 22 million would lose their coverage in the next decade, but the plan would save the government $420 billion.