While the effort to overhaul the federal health care law cleared the first hurdle in the Senate on Tuesday, it doesn’t end there. What comes next is a complicated process that includes 20 hours of debate, amendments and a so-called “vote-a-rama” where Senators will vote on dozens of amendments offered up by both parties before final passage of a bill.
The timeline and the outcome are not certain, but here are few things to look out for as the process unfolds.
Repeal and Replace
On Tuesday night, Senators voted down a revised version of the proposed Better Care Reconciliation Act that included amendments to allow insurers to sell health plans that do not meet ACA requirements as well as an additional $100 billion to help people covered under the Medicaid expansion move into the private insurance market. Under Senate rules, the bill needed 60 votes to advance, but it fell short with 43-57.
On Wednesday afternoon, the Senate voted on a repeal-only bill that would eliminate the individual and employer mandates, Medicaid expansion, and premium subsidies under the ACA, while leaving in place protections for people with preexisting conditions and requirements for plans to provide essential health benefits.
Senators voted 55-45 against the straight repeal bill, which the Congressional Budget Office estimated would lead to 32 million more uninsured Americans.
If lawmakers are unable to agree on a broader repeal and replace strategy, it’s likely Senate leadership will pursue a stripped-down, or “skinny,” repeal plan that would end the least popular parts of the ACA – the individual and employer mandates and the tax on medical devices – with no changes to the Medicaid program, subsidies for private insurance or other regulations.
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