clock menu more-arrow no yes mobile

Filed under:

Somebody tell the United States Senate they are voting on a real bill

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.

Senate Republicans are primed to pass some kind of health care bill in the next 24 hours.

The crazy thing is, they say they don't actually want it to become law.They just want to pass something and then start negotiations with the House on a much bigger bill. In fact, they want assurances that whatever they pass won't just be taken up by the House and passed.

Sen. Bob Corker (R-TN) told reporters that senators weren't concerned about the "substance" of the bill they're about to vote on, they just want a guarantee the House won't pass it too.

What on earth.

Republicans are staring at two dramatically different paths. So-called "skinny repeal" could repeal only the individual mandate and little else (though the details are very fluid and bigger changes would still be added, making it a much huskier repeal).

Sarah explained why that is still a big deal, but it is a dramatic drop-off from where Republicans began their Obamacare repeal debate. Medicaid, most notably, would likely be left untouched.

Or they could try to salvage a bigger repeal-and-replace bill in House-Senate negotiations. That would put Medicaid back on the table for cuts and surely lead to bigger coverage losses than skinny repeal alone.

The uncomfortable truth for these Republican senators is they've been trying to do the latter for the past two months and they haven't been able to do it. It's not clear how adding the House to the mix could possibly help.

Scaled-back repeal might be the only viable end game. Adding to the confusion are widespread rumors that the House could vote on skinny repeal as soon as the Senate does.

So in a matter of hours, we could be heading into drawn-out conference negotiations — or skinny repeal could be the law of the land.

To demonstrate how divided Republicans still are, this is what Sens. Rand Paul (R-KY) and Ron Johnson (R-WI) have told me in the past two days. Paul supports skinny repeal and wants the repeal-and-replace bill to stay dead. Johnson feels very differently.

Sen. Rand Paul, on the idea of passing skinny repeal just to get to negotiations with the House:

"I'm gonna advocate that if we can get some repeal, that we just send it to the House for approval because I think if it goes to conference committee, it's gonna get built back up into the monstrosity that we just voted down. If we end up with a $300 billion insurance subsidy fund, I think conservatives will vote against that also."

Does it give him any hesitation to vote for skinny repeal, given the comments of his leadership?

"I think you have to vote for what you're for. I'm for repeal, and I'm for variations of repeal. So you vote for that, and you advocate for your position.

"I just talked to several senators who also agree with me, they'd like to see it go straight back to the House. I think if it goes to conference committee and it explodes in its breadth and expense, they're gonna have trouble getting the votes."

Sen. Ron Johnson, on how he'd feel if skinny repeal is the only thing Republicans in Congress can pass after seven months of debate:

"It's sad. It's very sad. It's very sad."

But is it better than nothing?

"If I vote yes, it's certainly saying it's better than the status quo, which is awful. You keep coming back to that. No matter how disappointing this is, how frustrating it is, you come back to the fact that these markets are collapsing."

He relayed the story of a Wisconsin family he said had to pay $15,000 back to the government because they had received Obamacare subsidies but their income ended up being higher than they expected.

"That's just sad and, truthfully, I don't see anything in any of these bills that really addresses those forgotten men and women."

Chart of the Day


Why skinny repeal isn't so skinny. This is what Sarah was getting at: So-called skinny repeal still destabilizes the insurance market and leads to millions fewer Americans having health insurance. We just call it quote-unquote skinny because we need a name for it. Read more from Vox's Jeff Stein and Alvin Chang.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

Analysis and longer reads

  • “States Have Already Tried Versions Of 'Skinny Repeal.' It Didn't Go Well”: “Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a "skinny repeal" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.” —Julie Appleby, Kaiser Health News
  • “Obama Stays Silent on Health Care Debate. Here’s Why.”: “Aides and advisers say that the former president is, like all Democrats, troubled by ability of Republican leadership to keep repeal efforts alive. One official said he did not expect GOP lawmakers to get even this far. But he is wary of engaging in a highly visible way, even in this critical hour, for fear that it would backfire politically.” —Sam Stein, Daily Beast
  • “Amazon has a secret health tech team called 1492 working on medical records, virtual doc visits”: “Amazon has started a secret skunkworks lab dedicated to opportunities in health care, including new areas such as electronic medical records and telemedicine. Amazon has dubbed this stealth team 1492, which appears to be a reference to the year Columbus first landed in the Americas.” —Eugene Kim and Christina Farr, CNBC

Join the conversation

Are you an Obamacare enrollee interested in what happens next? Join our Facebook community for conversation and updates.

Sign up for the newsletter Sign up for Vox Recommends

Get curated picks of the best Vox journalism to read, watch, and listen to every week, from our editors.