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Republican leaders just made a hugely important concession on the Senate health bill

McConnell’s own version of the bill will reportedly require 60 votes to pass.

Tom Williams/CQ Roll Call/Getty
Andrew Prokop is a senior politics correspondent at Vox, covering the White House, elections, and political scandals and investigations. He’s worked at Vox since the site’s launch in 2014, and before that, he worked as a research assistant at the New Yorker’s Washington, DC, bureau.

Senate Republican leaders have reportedly concluded that their particular version of the health care bill, the Better Care Reconciliation Act, will need 60 votes to pass under Senate rules — essentially ensuring that that particular version of the bill cannot pass this week.

But importantly, it still remains possible that Republicans can pass something — the repeal-and-delay bill (the Obamacare Repeal Reconciliation Act), the House bill (the American Health Care Act), or some kind of stripped-down “skinny” repeal — with a bare majority under the reconciliation process, so long as it abides by the chamber’s rules.

The problem, as Leigh Ann Caldwell of NBC News reported Tuesday morning, is that two major recent changes to Senate leaders’ bill — an amendment by Sen. Ted Cruz on insurance market regulation, and an amendment by Sen. Rob Portman on Medicaid — have not yet been scored by the Congressional Budget Office.

The lack of a CBO score means that we don’t know the budgetary implications for the newest version of the BCRA, and therefore, it doesn’t pass muster under the Senate’s budget reconciliation rules that allow certain measures to pass with just a majority vote.

Republican leaders could wait for the score to be completed. Instead, they’ve decided to rush to a vote this week — and that means the modified BCRA will need 60 votes to pass. Since Democrats are united against it and Republicans only have 52 seats, that means it will fail.

Sen. Rand Paul (R-KY) soon confirmed on Twitter that he’s been told by GOP leaders that is indeed their current plan:

However, Republicans will still be able to pass a bill with a simple majority — so long as it only includes provisions that have been previously scored by the CBO.

  • The GOP’s 2015 repeal-and-delay bill (the ORRA) fits that description.
  • So does the bill passed by the House of Representatives (the AHCA) — though the parliamentarian may strike some of its provisions.
  • So does Senate leaders’ bill without the Cruz and Portman amendments (the BCRA, which had to be modified because it didn’t have the votes — and again, parliamentarian changes would need to be made here).
  • And so would some sort of stripped-down bill featuring provisions that have been scored by the CBO already (the “skinny repeal” scenario).

So according to Caldwell’s sources, this is GOP leaders’ full current plan:

Here’s some more context for what this means:

  • Senate Majority Leader Mitch McConnell will first put up the “motion to proceed” (to open floor debate) on the House-passed bill.
  • Then, in a concession to conservatives, he will put up the “repeal-and-delay” bill that does nothing to replace Obamacare as a substitute amendment to that bill — but he expects it to fail to get a majority.
  • Then he will put up his own bill, the BCRA — but because it will require 60 votes due to the lack of a complete CBO score, that’s certain to fail too.
  • Finally, he will attempt to cobble together through amendments some sort of “skinny repeal” with policies he hopes 50 Republican senators can agree on. The goal here would be just to pass something, anything, to keep the process alive.
  • McConnell will apparently maintain that this won’t be the final bill but rather a vehicle to start a conference committee with the House of Representatives to agree on some sort of final piece of legislation. This would require another vote by the Senate later on whatever comes out of this conference committee (and theoretically, the full modified BCRA could have a CBO score by then and pass through reconciliation).

Again, though, to do all that, McConnell needs to win the vote on the motion to proceed first — and that’s this afternoon.

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