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The latest vote to repeal Obamacare fails in the Senate

But the debate lives on.

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The Senate failed Wednesday to advance a bill that would have partially repealed Obamacare without replacing it, another step in the Senate health care debate that is likely heading toward a much more scaled-down bill.

It was the second defeat for the biggest Republican promises to uproot the 2010 health care law. On Tuesday night, the Senate’s repeal-and-replacement bill, the Better Care Reconciliation Act, failed on a procedural vote, with nine Republicans opposing it.

On Wednesday afternoon, a cleaner repeal bill, the Obamacare Repeal Reconciliation Act, also failed, 45 to 55, with seven Republicans and all Democrats voting to block it.

The legislation would have repealed Obamacare’s spending on insurance coverage and its taxes on the wealthy and health care industries; it would not have included any new provisions to replace the law. The projected outcome, according to the Congressional Budget Office, would have been 32 million fewer Americans with health insurance 10 years from now without such a replacement.

Conservatives, led by Sen. Rand Paul (R-KY), had pushed for a vote on a clean repeal bill, and now they’ve gotten it. It is clear that repealing Obamacare without replacing it is not a viable option, even as Republicans now control all the levers of government. A repeal-and-replace plan also looks significantly short on support, after Tuesday’s votes.

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 through Wednesday and into Thursday on the House health care bill, which is technically the bill that Republican senators voted to take up Tuesday.

Here’s what is still to come.

  • Vote Wednesday afternoon on a Democratic motion to send health care to the committees.
  • 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.

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