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The past 24 hours in health care, explained

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

This is the web version of VoxCare, a daily newsletter from Vox on the latest twists and turns in America’s health care debate. Like what you’re reading? Sign up to get VoxCare in your inbox here.

The Better Care Reconciliation Act is dead. A clean (partial) Obamacare repeal bill is dead. Barring a miraculous resurrection, Senate Republicans' hopes of passing a major health care overhaul are dead.

It was an outcome months in the making, founded in the bitter divide between conservatives and moderates on how exactly to unwind the 2010 health care law they'd spent years opposing.

But the demise happened very quickly. We started Monday expecting a relatively slow week, after Sen. John McCain's health scare delayed any further action on the BCRA for the time being.

You'll never guess what happened next.

8:30 pm Monday: Sens. Mike Lee (R-UT) and Jerry Moran (R-KS) announce they will oppose the current version of the BCRA, bringing the number of opposing senators to four, enough to block the bill.

10:48 pm Monday: Senate Majority Leader Mitch McConnell shelves the BCRA and announces Senate Republicans will instead set up a vote on an updated version of the 2015 budget reconciliation bill that partially repeals Obamacare with a two-year delay.

10:03 am Tuesday: McConnell puts pressure on his members, noting that Senate Republicans passed the partial repeal bill just two years ago. “A majority of the Senate voted to pass the same repeal legislation. President Obama vetoed it then. President Trump will sign it now," he says.

10:35 am Tuesday: Sen. Susan Collins (R-ME), the only Republican to oppose the 2015 bill, tells NBC News she will vote against it again.

11:11 am Tuesday: Sen. Shelley Moore Capito (R-WV) says she will oppose the procedural vote to open debate for the repeal-without-replacement legislation. "I didn't come to Washington to hurt people," she says. With McCain out of town, the partial bill lacks votes to advance, at least until he returns.

12:36 pm Tuesday: Sen. Lisa Murkowski (R-AK) tells reporters she would also vote to block the partial repeal bill from advancing. “If we’re going to do repeal, there has to be replacement," she says. Collins, Capito, and Murkowski are enough votes to block the bill, even once McCain returns to Washington.

2:32 pm Tuesday: McConnell announces that Senate Republicans will nevertheless vote to start debate to move forward with the partial repeal bill in the near future. But unless one of the current opponents changes his or her mind, that vote will not have the support to pass.

3:28 pm Tuesday: Sen. Lamar Alexander (R-TN), chair of the Senate health committee, announces he will hold hearings on the individual market after the Senate votes — a signal that Republican leaders might be prepared for the partial repeal bill to fail.

Chart of the Day

NICHM Foundation

The big spenders in health care. It's a truism in health care that a small number of people account for a big chunk of the spending. This chart puts that into sharp relief: The top 1 percent of spenders account for 20 percent of spending, and the top 5 percent for nearly 50 percent. Read more from Sarah on America's health care cost problem.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

Analysis and longer reads

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