Understand how we got here — and how to move forward.


July 25, 2017

Senate advances GOP health care bill. What's next?

Daily Briefing

    Editor's note: This developing story was updated at 8:02 p.m. ET.

    The Senate on Tuesday voted 51-50 to proceed to debate on health care legislation. All Democratic senators and GOP Sens. Collins (Maine) and Murkowski (Alaska) voted against the measure, while the remaining 50 Republican senators voted in its favor, and Vice President Pence cast the tiebreaking vote.

    Here's what we know—and don't know—about the next steps.

    What did the Senate just vote on?

    The Senate technically voted to proceed to debate on the House-passed American Health Care Act (AHCA). However, "nobody expects that bill to become law," Thomas Kaplan and Reed Abelson write for the New York Times. Instead, Senate GOP leaders plan to adopt an amendment or several amendments that would either significantly modify the AHCA or replace it completely with an alternative plan.

    What happens now?

    20 hours of debate, then a vote-a-rama

    Tuesday's vote sets up 20 hours of Senate debate, split evenly between Democrats and Republicans. The Senate has the option of recessing during that time, so the 20 hours may or may not happen consecutively. Either party can also opt to waive some of its time, Margot Sanger-Katz writes for the New York Times' "The Upshot." The Senate can vote on amendments during this time, but the time spent voting on amendments does not count toward the 20 hours of debate, Julie Rovner reports for Kaiser Health News.

    After the 20 hours of debate concludes, senators from both parties will be able to offer an unlimited number of amendments, as long as they would not add to the budget deficit and are "germane" to the bill. This process is known as the vote-a-rama. Sanger-Katz reports Democrats likely will try to to "force their Republican colleagues to go on the record making as many tough votes on health care policy as they can."

    In reality, lawmakers won't truly be able to offer an unlimited number of amendments, Sanger-Katz writes, "since the senators do have to stick around and vote on them, and they will need to sleep eventually."

    The first amendments and the overall plan (subject to change)

    Leigh Ann Caldwell and Vaughn Hillyward report for NBC News that GOP leaders plan to start with votes on two amendments. One amendment would replace the House bill shell with the updated version of the GOP's "repeal-and-delay" bill. It would immediately repeal the Affordable Care Act's (ACA) coverage mandates and taxes, but would delay repeal of its coverage expansions by two years, with the hopes of passing a replacement plan sometime in the interim.

    That "repeal-and-delay" measure, which would require 50 votes to advance under Senate rules, is "expected to fail," NBC News reports, as three GOP senators—Susan Collins (Maine), Lisa Murkowski (Alaska), and Shelley Moore Capito (W. Va.)—have already stated their opposition to the measure, and the party can afford to lose only two GOP votes.

    The other initial amendment the Senate will vote on would replace the House bill with the latest version of the Better Care Reconciliation Act (BCRA), which would fundamentally reform Medicaid financing and repeal major portions of the ACA. That vote is also "likely to fail," NBC News reports, especially because it may be subject to a 60-vote threshold under Senate rules due to of provisions added under a deal between Sens. Rob Portman (R-Ohio) and Ted Cruz (R-Texas), NBC News reports. Three GOP senators—Rand Paul (Ky.), Mike Lee (Utah) and Jerry Moran (Kan.)—have stated their opposition to a previous version of the BCRA, and several others had expressed concern.

    If both those votes fail, The Hill reports that GOP leaders are considering advancing a bill that would repeal only the ACA's individual mandate, employer mandate, and medical device tax. GOP leaders hope such a plan could receive the 50 votes needed for passage, after which they would set up a conference committee to negotiate a final bill with the House.

    Any final bill would then need to be voted on by the House and the Senate and signed by President Trump.

    (Scott/Stein, Vox, 7/25; Sullivan, The Hill, 7/25; Owens, Axios, 7/25; Ann Caldwell, NBC News, 7/25; Sanger-Katz, "The Upshot," New York Times, 7/25; Kaplan/Abelson, New York Times, 7/25; Rovner, Kaiser Health News, 7/25).

    Why investing in consumer loyalty is a no-regrets strategy

    Join us on Friday, August 4 at 1 p.m. ET to learn how to generate consumer loyalty and why investing in loyalty is a no-regrets strategy regardless of business model—and no matter what happens with ACA repeal.

    Register for the Webconference

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.