July 26 (UPI) -- The U.S. Senate narrowly voted Tuesday to move ahead with efforts to repeal and replace the Affordable Care Act -- with only Republicans supporting the measure -- but hours later rejected a bill that would have accomplished the long-held GOP goal.
The rejected legislation was a modified version of Senate Majority Leader Mitch McConnell's Better Care Reconciliation Act, a comprehensive effort to replace the ACA. It needed 60 votes to overcome parliamentary barriers but fell short, with only 43 in favor and 57 opposed, including nine Republicans.
The strong objection to the BCRA, the Senate version of the House's American Health Care Act, by many in McConnell's own party indicates Republicans are still far from a consensus over how to replace the Obama-era law with a more GOP-friendly healthcare bill.
The rejection of McConnell's plan occurred soon after Republicans narrowly won a procedural vote to debate a repeal-and-replace plan -- in which Vice President Mike Pence, the Senate's president, broke a 50-50 tie.
McConnell had scheduled a procedural vote even though it was uncertain what the replacement might look like. The senators voted on proceeding to debate the bill with numerous amendments certain from extremes of the political spectrum.
GOP senators who opposed the latest Senate proposal but backed the procedural motion were Rand Paul of Kentucky, Dean Heller of Nevada, Shelley Moore Capito of West Virginia, Rob Portman of Ohio, Mike Lee of Utah and Ron Johnson of Wisconsin.
The procedural vote, called a motion to proceed, occurred after the Senate convened at noon Tuesday. Its success allowed the upper chamber to begin mulling the AHCA and BCRA.
The House and Senate plans both scrap the financial penalty for citizens who don't purchase coverage. Both plans also reduce Medicaid coverage, which moderates oppose, and keep some of the regulations in the ACA unpopular with conservatives. Between 21 million and 32 million -- depending on the plan -- would lose their health insurance by 2026, according to analyses by the Congressional Budget Office. The House narrowly approved its plan in March.
A key difference in the Senate bill is the additional taxes on the wealthy would be retained, but it also includes the option for bare-bones health plans.
Sen. John McCain, R-Ariz., made a dramatic return to the Senate in time to cast his yes vote Tuesday after taking time off for brain cancer treatment. Doctors discovered the tumor July 14 during surgery to remove a blood clot.
The 80-year-old senator received a standing ovation in the chamber Tuesday and was embraced by his colleagues from both parties. His appearance was reminiscent of Democratic Sen. Ted Kennedy's return in 2008, one year before the ACA was approved.
McCain, who had a 2- to 3-inch scar over his left eye, said he would not support the "bill as it is." But later, he did vote in favor of the latest GOP bill.
After the procedural vote, McCain urged a bipartisan effort, and for his colleagues to "stop listening to the bombastic loudmouths" on radio, television and the Internet who oppose compromise.
"To hell with them!" McCain said.
He also said members are Congress are not "subordinates" to the president, and instead are "equals."
After the vote, President Donald Trump thanked McCain for making the trip from Arizona and called him "a very brave man" during a joint press conference with Lebanese Prime Minister Saad Hariri at the White House.
"I'm very happy to announce that with zero of the Democrats' votes, the motion to proceed on healthcare has moved past and now we move forward toward truly great healthcare for the American people. We look forward to that," Trump said.
Before the vote, a group of protesters shouted "kill the bill'" and "shame" from the Senate's galleries.