Will Mitch McConnell emerge as a happy health care camper today?
Alex Wong — Getty Images
By Sy Mukherjee
July 25, 2017

After a successful preliminary health care vote on Tuesday, Senate GOP leaders may have a new plan to get their health legislation over the finish line: pass what, in effect, could amount to a blank legislative check.

Senate Majority Leader Mitch McConnell began a successful “motion to proceed” vote on the chamber’s Obamacare repeal bill around 2:30 pm Tuesday. This was a procedural vote, not one on any particular piece of legislation. In fact, having secured those 50 votes on the motion to proceed (plus a necessary tie-breaking vote from Vice President Mike Pence) the Senate must now move on to followup debate on multiple health care bills being tossed around by GOP leadership in the coming days. “Let the voting take us where it will,” as McConnell put it while presiding over the vote.

Senators Lisa Murkowski of Alaska and Susan Collins of Maine, who has consistently opposed the GOP efforts, were the only Republican Senators to oppose the motion in addition to all Democrats.

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But now that the procedural hurdle has been passed, the broader health bills that will (reportedly) be considered in the coming days, in the form of “amendments” that would supplant the basic legislative vehicle the Senate used to begin official debate Tuesday, face an uncertain future. These include multiple versions of the Senate’s Better Care Reconciliation Act and a “repeal-and-delay” strategy, each of which is potentially doomed thanks to previously stated opposition from a mix of conservatives and moderates. However, there are reports that the GOP’s newest plan is a so-called “skinny repeal”—legislation that would undo: Obamacare’s individual mandate requiring people to carry health insurance or pay a penalty; a mandate on employers to cover full time workers; and a tax on medical device companies.

Those are some of the most unpopular parts of Obamacare. (Though it’s important to note the Congressional Budget Office and other nonpartisan scorekeepers have projected that repealing the individual mandate—which is meant to prevent people from only buying guaranteed insurance coverage when they’re sick—would lead to massive premium increases.) But there’s almost zero chance that’s the legislation that could ultimately reach President Trump’s desk.

For one, it doesn’t do much to actually dismantle Obamacare—it simply addresses some of its enforcement and funding mechanisms. That’s a far cry from the far-reaching American Health Care Act passed by the more conservative House of Representatives earlier this year, which would gut numerous Obamacare protections and massively scale back the Medicaid program for the poor and disabled, as well as from the BCRA.

So what’s the goal here? Essentially, passing a “skinny repeal” could launch a “conference committee” with the House that would, ostensibly, produce a final, final health care deal between the two legislative chambers that would, in all political likelihood, look little like a skinny repeal (if that even passes). In fact, Arizona Sen. John McCain himself—who made a dramatic return to the Senate on Tuesday following a recent brain cancer diagnosis—slammed the “shell” health care bill (it’s unclear exactly which possible version he was referring to), in a speech to the Senate just minutes after he voted “aye” on the motion to proceed. He called on a bipartisan bill to shore up health insurance markets.

For now, it’s still unclear what kind of health care legislation the Senate will vote on, what may ultimately pass, and what the future holds for negotiations with the House if something does pass.

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