Senate Votes to Proceed with ACA Repeal

This vote will open the Senate floor for 20 hours of debate that will be evenly divided between Republicans and Democrats.

Republicans are now expected to vote on multiple versions of health care repeal legislation, including a full repeal bill that was presented in 2015. However, it is unlikely that a full repeal bill will gain the 51 votes needed to pass.

Furthermore, Senators will vote on individual amendments within the bill, which can be proposed by both Republicans and Democrats. These amendments will likely include all of the provisions in the previously drafted Better Care Reconciliation Act (BCRA).

A number of the BCRA’s amendments will require 60 votes to pass, after the Senate Parliamentarian deemed them in violation of the Byrd Rule. Therefore, aspects of the BCRA—like the controversial Cruz Amendment which would allow for unregulated, cheaper off market plans—are unlikely to pass.

The cumbersome voting process currently unfolding will also include “substitution” votes, meaning there will be amendments voted on that replace the entire text of the underlying health care bill. It is likely that at the closing of debate, Senate Majority Leader Mitch McConnell (R- Kentucky) will offer a final amendment substituting the bill with a “skinny” version of the ACA repeal. It has been widely reported that this skinny version will only include a repeal of the individual mandate and various taxes associated with the ACA.

At the close of debate, the Senate’s version of the bill will move back into conference with the House of Representatives before moving on to the President’s desk. It is likely that the bill will change again during this process.

Originally published in First Report Managed Care.