Senate Republicans' effort to repeal ACA has only just begun

WASHINGTON – Leaders of influential conservative organizations took a moment to cheer the Senate's vote to advance efforts to repeal the Affordable Care Act on Tuesday — but there is sober recognition that Republicans remain sharply divided over the details of that process.

The motion to proceed to a floor debate on the ACA repeal legislation passed narrowly, 51-50, as conservative and GOP-aligned groups from across the right-leaning ideological spectrum warned that they would count any vote against the measure as a vote to keep the ACA in place.

But just because the Senate agreed to move forward does not guarantee a final repeal bill will pass. The Senate will now move to a debate and amendment process as part of an effort to cobble together enough votes to shepherd through a repeal bill, a goal that has so far proved elusive at every turn.

"It's time to buckle in and grab the popcorn, because I think this upcoming debate and the amendments that are going to be offered and voted on will finally bring some accountability to the Senate," said Andrew Roth, vice president for government affairs at Club for Growth, a deeply conservative organization that supported the motion to proceed but backs a much more comprehensive approach to repealing the health care law than many more moderate lawmakers embrace.

Asked whether he expected the amendment process to be contentious, Roth replied, "to say the least."

Many senators who voted to proceed to debate have cited their interest in an open amendment process, and leaders of several conservative groups said they will be watching closely, and engaging in, amendment fights.

Americans for Prosperity (AFP), a major conservative organization backed by the Koch brothers, which has been deeply involved in the ACA repeal debate, is zeroing in on a repeal-only bill that passed in 2015 and can come up again now as an amendment. It's a measure embraced by a number of other conservative groups, including Club for Growth.

"We're going to key vote it, they've promised it in four consecutive election cycles," Tim Phillips, the president of AFP, said in an interview. Nearly every GOP senator "who will be voting on 2015 repeal voted for it when it came up during the Obama years, so it would be stunning to see any of them change their vote now that we have a Republican president who would sign it."

Sen. Susan Collins, R-Maine, is the only current GOP senator who opposed the 2015 bill, which was vetoed by President Barack Obama, though such an amendment looks unlikely to pass now.

Meanwhile, some anti-abortion rights groups, such as the Susan B. Anthony List, will be especially focused on any amendments that relate to Planned Parenthood defunding, one of many hot-button issues entwined in the health care debate.

"We have been very involved in the process thus far and will now follow every single amendment," said Marjorie Dannenfelser, president of the Susan B. Anthony List, saying Tuesday's vote offered "the momentum we needed."

Other major conservative organizations, including ­Heritage Action, also stressed that their attention now moves to the amendment process.

"Multiple key votes are possible throughout the amendment process," said a release from the group, meaning that the organization may highlight, and seek to engage its supporters around, individual amendments that arise in the next phase of Senate debate.

On Tuesday, conservatives said Republican senators dodged what would have been enormous political backlash from the base by voting to advance the debate — and warned them that that backlash could still come if they don't find a way to get the bill through the Senate.

"A failure to replace Obamacare could be devastating to a lot of folks who were counting on this to happen," said Lance Lemmonds, the communications director at the Faith and Freedom Coalition, another major conservative group focused in part on social issues. The organization was supportive of the motion to proceed, and Lemmonds called it a "good first step." But he said that the pressure remains on.

"It's a real danger for Republicans in the Senate, in the House, both, that if this isn't done and isn't done this year, that a lot of their conservative voters will be discouraged," he said. "That's never where you want to be going into a midterm election."