Sen. John McCain, R-Ariz. (Photo: McCain's Office)

Vice President Mike Pence today voted to break a 50-50 tie in the Senate on whether to proceed with floor debate on a measure that could change the Affordable Care Act.

All Democrats in the Senate voted against the motion to proceed with debate. Sen. Susan Collins, R-Maine, and Sen. Lisa Murkowski, R-Alaska, also voted against proceeding with debate.

Sen. Dean Heller, R-Nevada, and a number of other Republican senators who have expressed concerns about Republican efforts to change the Affordable Care Act, including Sen. John McCain, R-Ariz., all voted to proceed with debate.

(Related: Senate to Vote on Health Insurance Bill Debate Next Week)

The bill coming to the Senate floor for consideration, H.R. 1628, qualifies for special treatment under Senate budget reconciliation procedures. Those procedures let a bill avoid a filibuster, or endless round of Senate debate, with just 51 votes, not 60 votes.

The budget reconciliation rules let any senator offer an amendment to a budget reconciliation measure on the Senate floor.

Senate Republicans have debated several different versions of H.R. 1628 in recent weeks. Senate leaders identified the version subject to the motion to proceed as H.R. 1628, the “Budget Reconciliation Act” (BRA) bill.

The BRA version appears to be a bill that would repeal Affordable Care Act taxes, penalties and commercial health insurance subsidy and stabilization programs, without providing replacements for the current commercial health insurance subsidy and stabilization programs.

The vote to proceed simply lets senators begin debate on the bill. There is no guarantee that the Senate will pass the bill that emerges from the debate.

The outcome is relevant to all financial professionals, because the nature of any Affordable Care Act changes that do or do not come out of the process will affect what kinds of changes lawmakers can make to the tax code.

McCain, who returned to the Senate from emergency treatment for a blood clot above his eye, after discovering that he has brain cancer, with a bloody surgery scar on his forehead, rose immediately after the vote to say that he is supporting efforts to debate an Affordable Care Act change bill, not the current text of the BRA bill.

“I will not vote for this bill as it is,” McCain said, calling the bill a shell.

McCain argued that the current problems with the bill are partly the result of Republicans refusing to work in a bipartisan way with the Democrats.

The Democrats passed their health insurance bill without any Republican support, and that was a mistake, McCain.

“We shouldn’t do the same with ours,” McCain said.

If the current bill fails, then the Senate should return to regular order, rather trying to pass a bill through the budget reconciliation process, and it should see what Sen. Patty Murray, D-Wash., and Sen. Lamar Alexander, R-Tenn., can do at the Senate Health, Education, Labor and Pensions Committee, McCain said.

“What do we have to lose by trying to work together?” McCain asked. “We’re not getting much done by working apart.”

McCain also called for colleagues to recognize the importance of their role in the policymaking process.

“We’re not president’s subordinates,” McCain said. “We’re his equals.”

— Read Video: ACA Hearing Witness Says Congress Is ‘Under Literal Siege’ on ThinkAdvisor