By Mara Lee | July
25, 2017
The Senate on Tuesday voted to start debate on repealing and
replacing the Affordable Care Act, despite dissent from some Republicans who
still don't know what version of the bill they're considering.
The Senate now has 20 hours over several days to debate, and then an unknown amount of time to make amendments before a final bill on how to reform the individual insurance market and change federal Medicaid funding.
Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, voted against taking up the bill. Vice President Mike Pence delivered the tie-breaking vote on the procedural motion.
Before the roll call began, about a dozen spectators including some in white coats in the galley started chanting, "Kill the bill, don't kill us."
Senate Majority Leader Mitch McConnell, R-Ky., will have no time to savor this hard-won victory. He will still need to woo three or four conservative senators to support what they see as a new entitlement: providing financial help to buy private insurance. Conservatives want to make sure that some customers can buy cheaper insurance on the individual market.
Since Obamacare remade the individual market by opening it to all customers and standardizing benefits, premiums have risen by nearly 100%, a burden for those who earn too much to qualify for subsidies.
But there are even more senators who want to preserve Medicaid expansion in their states — more people gained coverage through Medicaid than buy policies on the exchanges.
Any change McConnell makes to appeal to conservatives loses votes in the center.
To make it even more complicated, only provisions that reduce the budget deficit can be included in the bill, because only budget-related bills are allowed to proceed with a 51-vote rather than 60-vote majority. The parliamentarian has already signaled that she does not believe that the Republican replacement for the individual mandate meets that standard. Republicans intended to impose a six-month waiting period to get individual insurance for those who either choose not to buy, or who buy a skimpy policy, if that returns as an option.
The parliamentarian has also nixed a simple-majority vote for any bill including conservatives' proposal to defund Planned Parenthood for one year, which could cause problems if the bill were to pass, and return to the House of Representatives for a final OK.
Former Republican staffer Chris Jacobs, of the Juniper Group, wrote that Republicans should have rejected the motion to proceed, warning that what would follow would be "a policy morass that could make the confusing events of the past week look tame by comparison."
After debate, all senators, including Democrats, will be allowed to offer amendments in a process colloquially called a "vote-a-rama." But at the very end, McConnell can bring forward a substitution with new items that weren't part of the amendment process or the original bill. Senators would have virtually no time to evaluate it before voting.
The Senate now has 20 hours over several days to debate, and then an unknown amount of time to make amendments before a final bill on how to reform the individual insurance market and change federal Medicaid funding.
Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, voted against taking up the bill. Vice President Mike Pence delivered the tie-breaking vote on the procedural motion.
Before the roll call began, about a dozen spectators including some in white coats in the galley started chanting, "Kill the bill, don't kill us."
Senate Majority Leader Mitch McConnell, R-Ky., will have no time to savor this hard-won victory. He will still need to woo three or four conservative senators to support what they see as a new entitlement: providing financial help to buy private insurance. Conservatives want to make sure that some customers can buy cheaper insurance on the individual market.
Since Obamacare remade the individual market by opening it to all customers and standardizing benefits, premiums have risen by nearly 100%, a burden for those who earn too much to qualify for subsidies.
But there are even more senators who want to preserve Medicaid expansion in their states — more people gained coverage through Medicaid than buy policies on the exchanges.
Any change McConnell makes to appeal to conservatives loses votes in the center.
To make it even more complicated, only provisions that reduce the budget deficit can be included in the bill, because only budget-related bills are allowed to proceed with a 51-vote rather than 60-vote majority. The parliamentarian has already signaled that she does not believe that the Republican replacement for the individual mandate meets that standard. Republicans intended to impose a six-month waiting period to get individual insurance for those who either choose not to buy, or who buy a skimpy policy, if that returns as an option.
The parliamentarian has also nixed a simple-majority vote for any bill including conservatives' proposal to defund Planned Parenthood for one year, which could cause problems if the bill were to pass, and return to the House of Representatives for a final OK.
Former Republican staffer Chris Jacobs, of the Juniper Group, wrote that Republicans should have rejected the motion to proceed, warning that what would follow would be "a policy morass that could make the confusing events of the past week look tame by comparison."
After debate, all senators, including Democrats, will be allowed to offer amendments in a process colloquially called a "vote-a-rama." But at the very end, McConnell can bring forward a substitution with new items that weren't part of the amendment process or the original bill. Senators would have virtually no time to evaluate it before voting.
Mara Lee covers developments in health care
policy in Congress and around Washington. This is her second time covering the
Hill. In a previous life, she covered Midwestern delegations for Scripps and
Gannett newspapers in Indiana and Michigan. Over her 20-year-plus-career, she’s
spent more time outside the Beltway, both as a business reporter for The
Hartford Courant and nine years in Ohio, mostly at the Dayton Daily News. She
won an award for coverage of Oxycontin addiction Ohio in 2003, as well as for Census,
business and breaking news coverage in Ohio and Connecticut. She’s a Virginia
native, and graduated from the University of North Carolina-Chapel Hill.
Twitter handle: MaraRhymesSarah
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