Senate Republicans voted Tuesday to take up debate on the House-passed healthcare bill, the American Health Care Act, with several steps remaining before the Senate can move the vote on to conference. Depending on the variables, a final vote in the Senate could be held as early as Friday.
Republicans voted along party lines to advance debate, and ended up with a 51-50 vote, which included a tie-breaker from Vice President Mike Pence. They will need to land similar numbers to advance a final bill.
Here are the steps to watch for in the coming days:
1. Replacing the House-passed bill. The American Health Care Act will be swapped for an amendment, which is another piece of legislation called the Obamacare Repeal Reconciliation Act, which is the bill that senators approved in 2015. It would repeal Obamacare’s taxes, mandates and spending but leave in place regulations on insurers and give lawmakers two years to come up with a new plan. Conservatives favor this route and point out that senators supported the same bill when Barack Obama was president and vetoed it.
This amendment, from Senate Majority Leader Mitch McConnell, R-Ky., is expected to be the first of dozens of amendments. After the bill is read in full, as Democrats requested, two hours of debate time will open.
2. Second amendment offered, but voted on first. This amendment will be the Better Care Reconciliation Act, the bill that Senate Republicans wrote behind closed doors and have been debating for several months. It also will include an amendment by Sen. Ted Cruz, R-Texas. The amendment, known as the “Consumer Freedom Amendment,” would allow insurers to offer cheaper plans that cover a smaller range of benefits as long as they offer one plan that has the essential health benefits included under Obamacare. The provision has been controversial among Republicans who say that it would make coverage for people with pre-existing illnesses prohibitively expensive.
The Better Care Reconciliation Act also will include a provision for people who will be moved off Medicaid expansion, called the Medicaid wraparound. The move is aimed at addressing the concerns of senators who were on the fence but ultimately voted to support the motion to proceed, such as GOP Sens. Shelley Moore Capito of West Virginia, Rob Portman of Ohio and Dean Heller of Nevada. All had said that they would debate the bill but wanted to ensure that people on Medicaid would be protected.
These proposals will need 60 votes to pass because the Cruz amendment and the Medicaid provision have not been scored by the Congressional Budget Office. They could resurface again during conference, which would give Republicans more time to obtain a CBO score for them.
Several other provisions would need 60 votes for passage, including anti-abortion provisions, a measure to charge seniors higher premiums and a provision that would let small businesses bypass Obamacare insurance rules. These portions of the bill don’t meet reconciliation rules, according to recommendations from the Senate parliamentarian, and are likely to be stripped out.
3. Debate for 20 hours and propose amendments. After the first two amendments are introduced and voted on, with the Better Care Reconcilation Act voted on first, other amendments will be voted on, from Republicans and Democrats. Twenty hours of debate will be scheduled, which can be paused and do not include the amount of time spent voting on amendments.
4. Vote-a-rama. The voting cycle can last for as long as senators continue to introduce amendments. Typically each member takes a minute or two to discuss the amendment, from a Democratic and a Republican perspective, and the voting continues until senators cannot go on anymore. Vote-a-ramas typically do not go beyond 24 hours. 5. Crafted bill, with amendments, becomes conference-bound. Once the amendments have been voted on, a final vote will occur and the bill will be sent to conference, where more details are likely to be hashed out with members of the House.
