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Senate advances health care bill as McCain makes dramatic return, Pence breaks tie

WASHINGTON -- Senate Republicans voted to advance to floor debate on their efforts to repeal and replace Obamacare.

Vice President Mike Pence cast the tiebreaking vote.

In a dramatic moment, Sen. John McCain returned from Arizona to applause from fellow senators. He cast a necessary Republican vote for the motion after two GOP senators -- Susan Collins and Lisa Murkowski -- sided with all Democrats in opposition.

As the vote began, protesters in the Senate gallery shouted "kill the bill" and "shame, shame, shame!"

The vote came as Senate Majority Leader Mitch McConnell and President Donald Trump dared their fellow Republicans to block their seven-year campaign promise to repeal and replace Obamacare.

The next step is floor debate on the legislation to overhaul the Affordable Care Act even though there aren't any guarantees the votes are there to eventually pass it -- and it's unclear what a final bill will look like.

The vote was up in the air until the last moments, when Several Republican holdouts announced their support, including Sens. Rand Paul, Dean Heller, Rob Portman and Shelley Moore Capito.

Trump, who has repeatedly said he's ready to sign any repeal legislation, celebrated the vote, which creates a path to give him the major congressional victory that's eluded the White House thus far.

"I'm very happy to announce that with zero of the Democrats' votes, the motion to proceed on health care has moved past and now we move forward toward truly great health care for the American people. We look forward to that. This was a big step," Trump said at a White House news conference.

"I want to thank Sen. John McCain," he added. "A very brave man. He made a tough trip to get here."

Democrats are united against the bill, saying it would end health care coverage for millions of Americans.

Sen. Bernie Sanders Monday called the bill the "cruelest, most destructive and irresponsible piece of legislation ever brought to the United States Senate in the modern history of this country."

In a speech at the NAACP national convention, highlighted the possible effects of the bill's provisions, which include cutting Medicaid, defunding Planned Parenthood and roadblocks for those with pre-existing conditions.

Paul, Heller back motion

McConnell won over key holdouts, but those senators haven't said they will back the final measure.

Paul, a Kentucky Republican, said he will support the procedural vote to open debate on the health care bill, so long as leadership guarantees a vote on a full repeal of Obamacare.

"If this is indeed the plan, I will vote to proceed and I will vote for any all measures that are clean repeal," Paul tweeted. Such an amendment would be expected to fail, however.

Heller, who has complained that Obamacare repeal efforts could hurt Nevada residents dependent on Medicaid, nevertheless said he'd vote to move forward. Heller is up for a tough re-election campaign in Nevada next year.

"Obamacare isn't the answer, but doing nothing to try to solve the problems it has created isn't the answer either," Heller said in a statement. "If the final product isn't improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it."

Republican leaders Tuesday worked thread any needle they can to appease other holdouts.

"The only goal is to get onto the bill. Nothing happens until we do, so that's the only goal," a Republican aide said.

"These are the moments legislatively when you get creative. We're getting creative."

If it passes

Leadership was floating a strategy Tuesday morning that lays out a series of proposals that attempt to give everyone they want, even though nearly every element is destined for failure on the floor during the amendment process.

That strategy is as follows, in terms of amendment order:

The full repeal bill that Paul backs.

A bill including the "consumer freedom amendment" from that Sens. Ted Cruz and Mike Lee originally advocated for, that includes a request from Sen. Rob Portman for $100 billion in additional Medicaid funding. That would require 60 votes to pass.

The GOP bill proposed earlier this month that McConnell pulled when too many Republicans opposed it.

Finally, a "skinnier" repeal bill that repeals Obamacare's individual and employer mandates.

This story is breaking and has been updated.

Here is a breakdown of how each senator voted:

Republicans who supported: 50

Lamar Alexander, Tennessee

John Barrasso, Wyoming

Roy Blunt, Missouri

John Boozman, Arkansas

Richard Burr, North Carolina

Shelley Moore Capito, West Virginia

Bill Cassidy, Louisiana

Thad Cochran, Mississippi

Bob Corker, Tennessee

John Cornyn, Texas

Tom Cotton, Arkansas

Mike Crapo, Idaho

Ted Cruz, Texas

Steve Daines, Montana

Mike Enzi, Wyoming

Joni Ernst, Iowa

Deb Fischer, Nebraska

Jeff Flake, Arizona

Cory Gardner, Colorado

Lindsay Graham, South Carolina

Chuck Grassley, Iowa

Orrin Hatch, Utah

Dean Heller, Nevada

John Hoeven, North Dakota

Jim Inhofe, Oklahoma

Johnny Isakson, Georgia

Ron Johnson, Wisconsin

John Kennedy, Louisiana

James Lankford, Oklahoma

Mike Lee, Utah

John McCain, Arizona

Mitch McConnell, Kentucky

Jerry Moran, Kansas

Rand Paul, Kentucky

David Perdue, Georgia

Rob Portman, Ohio

Jim Risch, Idaho

Pat Roberts, Kansas

Mike Rounds, South Dakota

Marco Rubio, Florida

Ben Sasse, Nebraska

Tim Scott, South Carolina

Richard Shelby, Alabama

Luther Strange, Alabama

Dan Sullivan, Alaska

John Thune, South Dakota

Thom Tillis, North Carolina

Pat Toomey, Pennsylvania

Roger Wicker, Mississippi

Todd Young, Indiana

Republicans who opposed: 2

Susan Collins, Maine

Lisa Murkowski, Alaska

Tie-breaking vote: 1

Vice President Mike Pence

Democrats who supported: 0

Democrats who opposed: 48

Tammy Baldwin, Wisconsin

Michael Bennet, Colorado

Richard Blumenthal, Connecticut

Cory Booker, New Jersey

Sherrod Brown, Ohio

Maria Cantwell, Washington

Ben Cardin, Maryland

Tom Carper, Delaware

Bob Casey, Jr. Pennsylvania

Christopher Coons, Delaware

Catherine Cortez Masto, Nevada

Joe Donnelly, Indiana

Tammy Duckworth, Illinois

Richard Durbin, Illinois

Dianne Feinstein, California

Al Franken, Minnesota

Kirsten Gillibrand, New York

Kamala Harris, California

Maggie Hassan, New Hampshire

Martin Heinrich, New Mexico

Heidi Heitkamp, North Dakota

Mazie Hirono, Hawaii

Tim Kaine, Virginia

Angus King, Maine (Independent)

Amy Klobuchar, Minnesota

Patrick Leahy, Vermont

Joe Manchin, West Virginia

Ed Markey, Massachusetts

Claire McCaskill, Missouri

Robert Menendez, New Jersey

Jeff Merkley, Oregon

Chris Murphy, Connecticut

Patty Murray, Washington

Bill Nelson, Florida

Gary Peters, Michigan

Jack Reed, Rhode Island

Bernie Sanders, Vermont (Independent)

Brian Schatz, Hawaii

Chuck Schumer, New York

Jeanne Shaheen, New Hampshire

Debbie Stabenow, Michigan

Jon Tester, Montana

Tom Udall, New Mexico

Chris Van Hollen, Maryland

Mark Warner, Virginia

Elizabeth Warren, Massachusetts

Sheldon Whitehouse, Rhode Island

Ron Wyden, Oregon