President Donald Trump is optimistic on health care.
The Senate voted to move to debate on some version of a health bill Tuesday afternoon, and as far as Trump is concerned, “once you get that motion, it’s in pretty good shape,” he told the Wall Street Journal.
Typically the motion to proceed to debate is indicative of the vote on the final bill. (The Senate voted on 13 motions to proceed in 2016, for example, and nearly all those that passed eventually became law.) But this time, the process is uncertain — in part because the Senate still doesn’t know what it will eventually be voting on. The motion to proceed suggests that 50 Republican senators (plus Vice President Mike Pence, the tiebreaker) still want to pass something. But it doesn’t mean they can all agree on a plan.
Senate procedure requires Republicans to start their floor debate with the American Health Care Act, the health bill the House passed in May. Senate Majority Leader Mitch McConnell can substitute another bill for a final vote. Senators can also offer unlimited amendments during the process.
But it’s still not clear what that final bill will be. In the past 24 hours, three options have become clear, two of which seem unlikely to pass:
- As it stands, McConnell is pushing forward on debating the Senate’s revised Obamacare replacement plan, the Better Care Reconciliation Act first. But this version of the BCRA will likely need 60 votes to pass, due to Senate rules — all but ensuring its failure, since no Democrats will vote for it.
- McConnell has also proposed voting on the Obamacare Repeal Reconciliation Act, a full repeal of Obamacare’s spending and health insurance coverage expansion with no replacement, that would delay repeal for two years. But enough Republican senators have already said they oppose repealing Obamacare without a replacement to ensure the bill will sink.
- Now senators are discussing the possibility of a “skinny repeal,” which would do away with the Affordable Care Act’s individual mandate, the employer mandate, and the medical device tax but would leave the Medicaid expansion and most of Obamacare’s regulations intact. So far, this seems like the most passable piece of legislation — but it’s a far cry from the tax cuts, regulation changes, and Medicaid reforms conservatives in the House and Senate have wanted.
Trump, meanwhile, doesn’t seem to have a policy preference: He has been in favor of every iteration of Congress’s health bill plans — no matter how much or little it differs from the last version, or how much it breaks the many campaign promises he made last year.
It still remains possible that the Senate could pass something, but it’s looking less and less like the big repeal and replace Republicans set out to accomplish in January. Complicating things further, Sen. John McCain (R-AZ), who returned to Washington after brain surgery to vote for the motion to proceed, might not be present for the votes during debate. Because two Republicans, Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK), voted against opening debate at all, McCain’s vote was crucial in moving forward and could be again in the future. McCain also said that he wouldn’t vote for the Senate bill in its current form — though it’s not clear what he meant, given how many proposals are under consideration.
In all, none of this process indicates health reform that’s in “good shape” as Trump indicated. Republicans are one step closer to some kind of Obamacare repeal — but this motion to proceed doesn’t mean it’s smooth sailing.