On Tuesday afternoon, a majority of Republicans in the Senate narrowly voted to open debate on legislation that will either repeal, repeal and replace, or repeal some aspects – though it’s unclear which ones – of the Affordable Care Act. Sens. Susan Collins and Lisa Murkowski were the only two Republicans to join Democrats in voting against the bill, with Vice President Mike Pence breaking the 50-50 tie.
Up until the last minute, it was unclear whether Senate Majority Leader Mitch McConnell had secured the necessary votes to move forward. Sen. Ron Johnson held everyone in suspense as he engaged McConnell in a heated conversation on the Senate floor before casting the final vote. He had been sharply critical of McConnell in recent weeks, calling the majority leader’s conduct throughout the drafting process a “significant breach of trust.” Johnson voted to proceed nonetheless.
Does this mean Obamacare will be repealed?
We don’t know yet. It remains an open question whether Republicans will have anything to show for all their efforts by the time this process is over. Republican senators are still strongly divided over which versions of a bill they will support. Rand Paul, for instance, has repeatedly signaled he will only support the 2015 bill that repeals the ACA without replacing any part of it, while some of his colleagues have expressed a reluctance to take away their constituents’ health care without a replacement plan in place.
John McCain, who rushed back to the Capitol days after he was diagnosed with brain cancer to participate in Tuesday’s vote, said shortly after voting to open debate that he will not support this version. “It’s a shell of a bill right now,” McCain said.
So what happens now?
Now that Republicans have cleared their first hurdle, McConnell will open debate, which is limited to 20 hours, divided equally between those in favor of the legislation and those opposed to it. But it won’t necessarily be 20 hours straight, so this drama will likely drag out for several more days.
After debate, senators supporting either position will be able to offer as many amendments or “substitutions” as they like – even ones that functionally replace the entire bill. A separate vote will be held for each amendment. This process, known as vote-a-rama, can (and likely will) be used to force senators to cast politically damaging votes against protecting popular programs like Medicare and Medicaid.
What remains unclear, even after Tuesday’s vote, is which bill will emerge from debate as the favorite. Will it be the Better Care Reconciliation Act, which McConnell has been crafting in the shadows for months? Or will they substitute in the so-called “clean repeal” bill, passed by Republicans in the Senate in 2015 and still favored by Paul? Or will it be “skinny repeal,” a late-breaking favorite, which would repeal some provisions of the ACA, such as the individual mandate, while keeping others in place? McConnell could end up offering all three for a vote on the floor, but there is no guarantee any one of the three options could get the 50 votes McConnell needs.
After amendments have been offered, senators can raise “points of order” challenging the legitimacy, under Senate rules, of each amendment. (Several potential issues with the House bill have already been flagged by the Senate parliamentarian.)
When any outstanding disagreements have been resolved, McConnell can offer the final amendment – which, again, could be an entire bill that supersedes any and all of the earlier amendments voted on. The full Senate then will vote on a final piece of legislation. That version, if it passes, will be kicked back to the House of Representatives, where members will either need to pass the Senate’s version of the bill, or go back to the drawing board once again.