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Senate fails to advance one Obamacare repeal bill, but the debate is still going

Stay tuned.

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.

The Senate failed Tuesday night to advance Republicans’ long-gestating plan to repeal and replace Obamacare, an important step in the chamber’s ongoing health care floor debate that looks increasingly likely to result in a much more modest health care plan.

The Senate voted late Tuesday to take up a new version of a repeal-and-replace plan that senators have been working on for months (the Better Care Reconciliation Act, or BCRA). It would have scaled back the law’s tax subsidies, repealed Medicaid expansion, and overhauled the entire Medicaid program with a federal spending cap.

This revised iteration of the BCRA — which included an amendment by Sen. Ted Cruz (R-TX) to allow non-Obamacare plans back on the market paired with $100 billion in funding to partially offset the Medicaid cuts — was subject, because of the Senate budget rules, to a 60-vote threshold for a procedural vote. It failed handily, 43 to 57, with nine Republicans and all Democrats opposing it.

Next up: a vote on clean repeal of Obamacare’s spending and health insurance coverage expansion with no replacement, which is scheduled for midday Wednesday. That bill is also expected to fail.

Neither result would be a surprise. Health care lobbyists and Senate aides believe the most likely destination is a skinny Obamacare repeal bill that undoes the individual mandate, the employer mandate, and a few of the law’s taxes. The text of that legislation has not yet been released or scored by the Congressional Budget Office.

The Senate health care debate is still ongoing, though

Debate will continue on the House health care bill on Wednesday, which is technically the bill that Republican senators voted on.

Here’s what is still to come.

  • Vote on the clean partial repeal bill, the ORRA. The partial repeal bill would need 51 votes, but it is expected to fail as well because too many Republicans oppose repealing without a replacement.
  • The rest of the 20 hours of debate on the Senate floor. That’s 20 hours on the Senate floor, not 20 hours in the rest of the world, so those 20 hours could take a couple of days if senators pause for breaks. Democrats and Republicans will take turns making speeches about health care. Democrats can use certain tactics — like asking for a full bill to be read out loud — to make the process more painful. Some of that time has been consumed by the debates on the ORRA and BCRA.
  • Vote-a-rama. There will then be what’s called vote-a-rama — quick up-or-down votes on whatever amendments Republicans and Democrats offer on the bill. Amendments must be considered relevant to health care, and they need 51 votes to be approved. They would technically be amendments to the House bill, if the previous two Senate bills have already failed or not been voted on yet. Democrats plan to use this time to force Republicans to take votes on politically unpopular measures, even if those amendments have little chance of making it into the final bill.
  • Final bill. McConnell will eventually offer a final substitute, encompassing the actual plan that Senate Republicans want to pass. This could be the so-called “skinny repeal” bill that surfaced Tuesday morning.
  • Vote on passage. That needs 51 votes to pass. Vice President Mike Pence can break a 50-50 tie.