Yesterday the Senate began consideration of healthcare reform with a 50-50 vote on whether to proceed to the debate. Senator John McCain returned from surgery and cancer treatment to cast the 50th vote in favor. The tie was broken by Vice President Pence. All 48 Democrats were joined by Senators Collins of Maine and Murkowski of Alaska in voting no. Officially the vote was on whether to proceed to the unpopular House repeal and replace bill, which was immediately replaced in the debate by a different Senate repeal-and-replace bill, a carefully negotiated package that Majority Leader McConnell spent weeks crafting, with compromises to get conservatives like Ted Cruz of Texas and moderates like Rob Portman of Ohio on board. But nine Republicans voted no along with all the Democrats, showing how difficult it will be to find a majority to pass anything.
The next vote is likely to be on passing a simple repeal of the Affordable Care Act, which all the Republicans voted for last year when they knew President Obama would veto it. Now, concerns about what would happen to the millions of Americans who would lose their access to health insurance have caused some Senators to rethink their position, and this bill is not expected to pass either.
The legislative process is going to be extremely complicated because Republicans are using a budget bill to try to pass healthcare reform, because the Democrats cannot filibuster a budget bill. It can pass with a simple 51 vote majority. However, budget rules are numerous and arcane. They require that the content of the bill be related to taxes and spending, and the Parliamentarian has ruled that several important sections of the Republican bills are not germane to taxes and spending. They can be subject to a vote to remove them.
The other unusual aspect of passing a budget bill is that debate is limited to 20 hours of legislative time, which can be spread over several days or consumed in one day. After that, every amendment gets two minutes of debate and then the vote starts, usually lasting ten minutes instead of the usual 15 or 20. And the number of amendments on a budget bill is unlimited. This leads to what is known on Capitol Hill as the vote-a-rama; hours of consecutive votes on amendments.
Finally, Senator McConnell will offer a bill in the form of an amendment that seems to have the best chance of passing. It could be a revised repeal and replace bill that he thinks can get 50 votes, or if that seems impossible he may offer what is being called a “skinny repeal.” This bill would just eliminate the Affordable Care Act’s mandates that individuals buy plans and that employers with 50 or more employees provide coverage, as well as eliminate the law’s tax on medical device manufacturers. This way the Senate would be passing “something” and then the process would move to a conference committee where a group of Senators and House members would resume the effort to put together a package that can pass a final vote in both Houses.
ACA emailed its membership Monday with a message to send to the Senate. The phone number there is 202-224-3121.