What to expect in the Senate’s health care debate

Photo: Sam Bowman via Flickr

Reconciliation. Vote-a-rama. Budget points of order. What’s going on in the Senate?

The short version is that the Senate is going to spend at least the next few days (and nights) debating bills that would repeal and/or replace the Affordable Care Act.

It will vote on many amendments, from both Republicans and Democrats – some during a lengthy “vote-a-rama” offered by both Republicans and Democrats. And the whole process will be governed by budget reconciliation rules with the Senate Parliamentarian as the referee.

Three big bills (technically offered as amendments) will be part of the debate:

  1. A repeal bill (very much like the 2015 repeal bill that Congress approved and then-President Obama vetoed).
  2. A version of the Senate repeal-and-replace bill.
  3. And probably a “skinny bill” – which we haven’t seen yet as I write on July 25, but early reports are that it will wipe out the individual and employer mandates, and the medical device tax.

That may be it. It’s not clear if that has 50 votes but the idea is if the Senate can at least agree on this “skinny” option, it can kick it back to the House for further negotiations and maybe come up with something that enough Republicans (and probably no Democrats) can live with.

But the process is complicated – and it may go on for days.

Here are some guides to how the Senate will consider, amend, and vote on repeal legislation in the Senate. It started with the “motion to proceed” – a vote needed just to move legislation to the floor and start debate. It will end – well, we don’t know that yet.

To help you understand, try this piece from veteran Hill health reporter Julie Rovner at Kaiser Health News, “Who Knew Senate Health Bill Debate Could Be So Complicated?” Rovner explains what 20 hours of debate means, what a Vote-a-rama is (it may sound like fun but … trust me on this), a Byrd rule (excluding provisions that don’t fit the budget rules – meaning a lot of other policy pieces that lawmakers would put in if they were allowed)

Vox’s Dylan Scott has a similar explainer – and Vox’s Alvin Chang also has a simplified flowchart illustrating the expected pathway that makes it all mercifully clear.

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