Health Center Federal Policy

The Twists and Turns of the Senate Health Care Debate

Yesterday was a roller coaster of a day on Capitol Hill, as the Senate began debate on its version (or perhaps more accurately, versions) of health care legislation. So that advocates are able to remain up to speed, our team wanted to summarize what’s taken place so far and where we stand in the Senate. We’ll aim to keep the blog updated as major developments occur this week.

The first big vote yesterday was on the “motion to proceed,” a procedural vote that allows the Senate to bring up a bill for consideration. Technically, the bill they moved to proceed to is the House bill, also known as the American Health Care Act (AHCA). However, that bill is only the vehicle, or the “shell,” that made it possible for the Senate to move on to consideration of several other options. More on those below. Bottom line on the motion to proceed though – it passed, 50-50, with Senators Murkowski and Collins voting “no” alongside all the Democrats, and Vice President Pence breaking the tie.

Once the motion to proceed passed, the Senate’s plan became a little more clear. Basically the plan is to put up three different options for a vote, knowing that the first two will fail.

Those are:

  1. A slightly modified version of the Senate Better Care Reconciliation Act bill – modified by adding $100 billion for Medicaid expansion states and by adding the so-called Cruz amendment, which allows non-ACA compliant plans to be sold on the individual market. Because these two late-addition provisions haven’t been scored, that bill needed 60 votes to pass.
  2. A bill very similar to the “repeal and delay” package that passed in 2015 and was vetoed then by President Obama. This only needs 50 votes to pass.
  3. A new package, being called “skinny repeal,” that would be limited to repeal of three items from the ACA: the individual mandate, the employer mandate, and the medical device tax. The idea here is to find the “lowest common denominator” package – what can get 50 Senators to vote yes. Then the plan would be to move on to conference with the House over the August recess.

Last night, the Senate voted on Option 1 above. Surprisingly, it not only didn’t get close to the 60 vote threshold, it didn’t get close to 50. 9 Republican Senators (Collins, Corker, Cotton, Graham, Heller, Lee, Moran, Murkowski and Paul) voted no. This is a big development and a setback for Leader McConnell because it means that even if they’re able to get something like option 3 out of the Senate, the likelihood of passing a final final bill that looks like the AHCA/BCRA is much lower.

Today, there will be a vote on Option 2 above – the “repeal and delay” bill. We don’t expect that to get the 50 votes necessary to pass. Democrats will also offer some “message” amendments that will not pass.

Then, starting Thursday, the Senate plans to return to the bill, finish debate, and head into what’s called “vote-a-rama,” where any Senator can offer any amendment and they typically go into the late/early hours. We’re not sure right now at what point during that process they’ll put forward Option 3, the “skinny” repeal bill. And we’re not sure, even when they do, if they’ll have the votes to pass it.

More good summaries for those interested here and here. To tune into the debate, visit And as always, let us know if you have questions at We’ll be summing all of this up and checking in on where we stand on these and other issues on our next Policy and Advocacy Webinar, scheduled for 3:30 p.m. Eastern next Wednesday, August 2. Register now!


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