The Senate narrowly voted today to move forward with its still-vague plan to repeal and possibly replace the Affordable Care Act (Obamacare). The vote itself was a nail-biter — but the high drama is only just beginning, as the Senate now has to hammer out the details of what, exactly, it is proposing to replace the ACA with.
The high-drama vote began just after 2:30 p.m., delayed a few minutes while the Senate Sergeant-at-Arms removed protesters shouting “Kill the bill; don’t kill us” and “Shame! Shame! Shame!” from the gallery. A New York Post reporter on the scene, Gabby Morrongiello, Tweeted that about 10 protesters were handcuffed and removed.
Morrongiello and Huffington Post reporter Jennifer Bendery both reported that reporters were being blocked from viewing the arrests and told that they could not take, and needed to delete, photos of the scene.
The vote began as an alphabetical roll call a few minutes later, during which time 47 of the Republican senators voted. Senators Susan Collins (ME) and Lisa Murkowski (AK) voted “no” on the motion to proceed; 45 other Republican senators voted yes.
The remaining “yes” votes slowly came in over the next half-hour, with the “ayes” from Sens. Jeff Flake (AZ), Dan Sullivan (AK), Jim Inhofe (OK) dribbling in over the following 20 minutes, and the deciding votes from Sens. Ron Johnson (WI) and John McCain (AZ), who spoke to applause, landing right around 3:00.
After that, the Democratic senators all registered their “no” votes. Vice President Mike Pence cast his tie-breaking vote at about 3:10, pushing the”ayes” to 51 and opening the bill to debate.
What did they vote on?
One of the many points of confusion leading up to today’s vote was that nobody actually knew what text would come up for a vote.
The bill that ultimately came up on the Senate calendar today was H.R. 1628 — the House’s American Health Care Act, that it passed in a narrow 217-213 vote back in May.
However, that doesn’t really matter; the vote today was essentially on placeholder text. The Senate voted today to open debate on a bill they still don’t actually have.
After the motion to proceed was carried, the Senate immediately moved to add amendments to the bill, to rename it to the Obamacare Repeal Reconciliation Act of 2017 and effectively turn it into an ACA repeal bill, along the lines of the “skinny repeal” that was widely rumored earlier today.
What happens now?
Today’s vote doesn’t actually reverse the ACA. Not yet. It was a motion to proceed, meaning now the Senate moves forward to consider the thing it just voted on.
In short, now the Senate gets to actually craft a real bill — but it’s probably still going to be a bit of a crunch.
The motion to proceed has kicked off a 20-hour period of debate. Those 20 hours, however, are legislative time, not real-time. Much in the same way that an hour of clock time in a football game can mean you spend half the day sitting in front of your TV, so, too, can these 20 hours stretch out for a while.
Once the 20 hours of debate are up, the process turns into an amendment fest, called a vote-a-rama. (Yes, really.)
In that vote-a-rama, amendments from both sides will be suggested, considered, and voted on in a rapid-fire, back-to-back way.
Senators will have perhaps ten minutes to consider and vote on each amendment that gets suggested, an unusual and exhausting process that can run through the night until dawn and that tends to leave Senators as confused as anyone else about what they’re actually voting on. Basically, whatever final bill ends up being crafted will be settled during that marathon proceeding, when or if it comes.
Vox has a color-coded flowchart outlining how the process goes from here, for the visually-minded.
Will they agree?
The Senators will have a great deal to debate among themselves now. In remarks he gave after the vote, McCain noted that in order for a final bill to gain his approval, it will have to undergo substantial changes. That’s a sentiment echoed by several Senators who voted in favor of the motion to proceed, all of whom have different desired outcomes and agendas.
The first and second drafts of the Senate’s repeal and/or replace plan met with objections from two diametrically opposed factions within the Republican caucus.
The first was helmed by Sens. Ted Cruz (TX), Ron Johnson (WI), Mike Lee (UT), and Rand Paul (KY). They, and the rest of the most conservative wing of the party, felt that the original proposals did not go far enough, and that the ACA should be fully and wholly repealed.
The other faction, helmed by Sen. Susan Collins (ME), is considered the more moderate wing. Collins, along with Senators Shelley Moore Capito (WV), Dean Heller (NV), John Hoeven (ND), Lisa Murkowski (AK), and Rob Portman (OH), all objected in some way to the Senate’s proposals made, especially deep cuts to Medicaid.
To get to the motion to proceed, McConnell only had to convince everyone except Collins and Murkowski that they could, during debate, craft a bill that would be acceptable to them. Now, the Senate actually has to craft that — and making those two factions agree on a common point isn’t going to be any easier now than it was two weeks ago.
But it’s definitely not good.
Every version of the ACA repeal proposed so far by the House or Senate results, at a minimum, in tens of millions of Americans losing access to health insurance.
The Congressional Budget Office estimated in May that the House bill (the text the Senate actually voted on today) would leave another 23 million Americans without insurance.
In June, the CBO then found that the Senate’s first-draft repeal-and-replace bill was just about as bad, and would likely lead to 22 million Americans losing their care.
And a straight, full repeal of the ACA, the CBO notes, would not only cause 32 million to lose insurance, but would also double premiums.
A huge array of groups have come out against the Senate’s plan, including health insurers, doctors, and hospitals; health-issue advocacy groups like the American Cancer Society and National MS Society; elder advocacy groups like the AARP; and of course all of the Democratic Senators.
President Trump, meanwhile, spoke glowingly of the Senate’s action today, saying, “I applaud the Senate for taking a giant step to end the Obamacare nightmare … The Senate must now pass a bill and get it to my desk so we can finally end the Obamacare disaster once and for all.”
No matter what compromise the Senate eventually settles on, say our siblings down the hall at Consumers Union, the policy and mobilization arm of Consumer Reports, it’s going to be bad for consumers.
“This entire process has been rushed, secretive, and ill-considered, resulting in proposals that are all fundamentally flawed,” Betsy Imholz, special projects director for Consumers Union, said in a statement.
“There should be no confusion that today’s votes to proceed are votes to repeal and take healthcare away from millions of families,” Imholz added. “No amendments, tweaks, or one-time payoffs can counteract the harm any of these options would cause. The future of our nation’s health system, and consumers’ health and financial security, is at stake. We implore Senators to stand up for the consumers they represent, abandon this ill-advised effort, and work in a bipartisan fashion to help consumers and strengthen the insurance markets.”
UPDATE: In a late-night vote, the Senate fell several votes short in its efforts to accept the Better Care Reconciliation Act. Following the Parliamentarian’s guidance, that legislation would have needed 60 votes, but only received 43. More amendments and more votes to come as the week goes on.
Editor's Note: This article originally appeared on Consumerist.