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Murkowski voted no on her party’s health care motion. Here’s why.

WASHINGTON — Alaska's senior Republican Sen. Lisa Murkowski said Tuesday that her decision to vote no on beginning debate on health care legislation was a last-minute decision. In the end, an allegiance to "the process" won out.

Alaska Sen. Dan Sullivan, also a Republican, voted yes, arguing that he was fulfilling a promise to his constituents to repeal the Affordable Care Act, and that the vote was necessary to begin debate on the Senate floor.

The vote Tuesday was on a motion to proceed with debate on a health care bill that passed the House of Representatives in May — though that's not the final product toward which Senate Republicans have been working. Over the next week, the Senate plans several more votes on larger pieces of legislation, 20 hours of debate, and then an "unlimited" amendment process that could carry on for days.

Whether they will arrive, at the end, at a bill that can muster 51 votes for passage is still unknown.

On Tuesday, Murkowski joined Sen. Susan Collins of Maine in voting no on the motion to proceed — the only two Republicans to do so. Vice President Mike Pence had to cast a tiebreaking vote to break the 50-50 deadlock.

"I voted no on the motion to proceed today because I didn't think that we were ready for the debate. And I have said pretty consistently that process really does matter, particularly when you're dealing with something that is as direct and personal as health care, something that has an impact on one-sixth of the nation's economy," Murkowski said in an interview Tuesday evening after the vote. "This is big, and then you throw in major Medicaid reform on top of that," she said.

Murkowski argued that revisions to the Affordable Care Act, often called "Obamacare," are necessary, but that the Senate process has not been conducive to crafting good policy, "enduring policy."

"And so my vote today was one that said, 'We're not ready to go to the floor to wrap this up,' " she said.

The scene on the Senate floor Tuesday afternoon had the serious, weighted feel of a dramatic moment in history. After lawmakers met with their party members in a weekly policy lunch, they headed to the Senate chamber, only yards away, and sat at their desks, awaiting a vote.

Soon, protesters appeared in the gallery above, shouting, "Kill the bill! Don't kill us!" and "Shame, shame, shame!" at the senators, who were seated in the chamber, unusually still and stoic. After their removal, protesters could still be heard in the hallways for several minutes, as votes began in the chamber.

Murkowski sat one seat from the center aisle, next to Collins, who would soon vote no — a bit louder than many of her colleagues up until that point. When the alphabet made its way to the "M" names, Murkowski stood to announce her "no," vote, surprising many in the galleries above.

She sat again, occasionally chatting quietly with Collins as the voting continued and the air in the room grew thick with tension. They would be the only two no votes for 30 minutes.

After half an hour of voting, Sen. John McCain, R-Ariz., who had been out after a brain cancer diagnosis, entered the chamber to a standing ovation from both parties, and cast his vote in favor of the motion to proceed.

After McCain's vote, Democratic senators began raising their hands to vote, and one after another cast "no" votes. Once the tally reached 50 to 50, Pence cast the tiebreaker, without much fanfare.

"The tension was very real," Murkowski said later that day, noting that there was no "roll call" during the Republican lunch, and that it was not entirely clear how the vote would pan out in the end.

It was at the policy lunch just before the vote when Murkowski decided to vote no, she said.

"Believe me, I went back and forth. I have been going back and forth on this since it was announced that we were going to have this vote today," she said.

"And at the end of the day, the process really matters to me," Murkowski said.

After votes concluded, McCain spoke in the chamber and drilled into his colleagues for a lack of a transparent process and bipartisan effort to move a health care bill forward.

"I listened very carefully to Sen. McCain's comments on the floor today. And I thought he hit it head on, in terms of reminding us that as the deliberative body here, there should be some meaning to that. And deliberation doesn't mean you just do it by yourself. Deliberation means that you bring in your colleagues, that you bring in all of your colleagues, even those that you disagree with. And you hash it out," Murkowski said.

Of course, McCain came to a different conclusion, and flew in from Arizona just for the vote. A long, stitched-up gash covered one eye, and his complexion was pale, a man facing down potentially deadly brain cancer.

"He did tell me, though … 'You did the right thing,' which made me feel good," Murkowski said of a conversation with the veteran senator right after the vote.

Whether many of the Republicans who voted Murkowski into office will agree remains unclear.

Tuckerman Babcock, chair of Alaska's Republican Party, wrote Tuesday that he was "proud" of Sullivan's vote, and "dismayed" by Murkowski's.

Murkowski was not deeply concerned about pushback from Alaska Republicans about her vote, she said.

"I base my votes on what I believe is in Alaska's best interest," she said. "So I know that there are those who wish that I would be more in line with following the party platform, but I don't think it should come as any surprise that there have been occasions that I have not followed the lead of the party," she said.

"So I appreciate the frustration, and I don't want people to think that because I didn't vote to proceed to debate today, that I think that the status quo is acceptable, that I don't think that there are certainly aspects of the ACA that I absolutely disagree with. We need to address it. We need to fix it," she said.

Sullivan said that voting to advance debate on the legislation amounted to keeping a promise to voters "to begin the process to repeal and repair" the ACA.

"Let the debate begin," Sullivan said after leaving the Senate floor Tuesday. "This is just the vehicle to begin the amendment process and the debate," he said.

Murkowski has not written off repealing and replacing the Affordable Care Act, she said Tuesday. And she still has some hopes for the amendment process this week.

She and Sullivan both pointed to a Medicaid provision they have been working on with Sen. Rob Portman, R-Ohio. She has hopes for amendments that will do more to manage high deductibles and premiums faced by many in Alaska. But because those amendments have not received "scores" on their likely costs from the Congressional Budget Office, they would require 60 votes for passage, she said. That's a steep requirement in the divided Senate.

Sullivan said that his focus will remain on repealing taxes and mandates and increasing support for Alaska's high insurance costs and opioid epidemic, while putting Medicaid spending on a "sustainable and equitable path."

In the end, the Senate will vote on "whatever survives," Murkowski said. What that will look like, she said, no one knows.

And Murkowski said that the adjustments made to the latest draft of the Senate bill alone — the Better Care Reconciliation Act — were not enough to get her vote.

"Based on where it was when it was released by the leadership, it still had not addressed many of the issues that we have in Alaska," Murkowski said. She pointed to problems with ensuring coverage for Alaskans living in poverty, and also the middle class.

"In Alaska you're talking about somebody who's making about $55,000, 60 years old, and half — almost half of their income, $22,000, close to $23,000, is what they're going to be on the hook for their deductible" under the Senate bill, she said.

"So as it was, we were not there yet. But again there were good folks that were working hard on ideas that I felt were addressing the concerns that people have," she said.

Whether the week ends in a repeal of the ACA or not, Murkowski said she expects the chairman of the Health, Education, Labor and Pensions Committee, Sen. Lamar Alexander, R-Tenn., to begin some kind of hearings on health care soon. Murkowski sits on the HELP Committee and has spent recent months arguing that the process should have begun there, though it has remained under the control of Senate Majority Leader Mitch McConnell.

If there is not a successful bill passage, Murkowski offered an "emphatic no" to the idea that repealing the ACA ends there.

"We can't just walk away from this and say we couldn't get it done. It's too big of an issue," she said.

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