What's Happening Today on Healthcare?

July 25, 2017



Sen. McConnell is expected to raise the procedural “motion to proceed” vote on the GOP ACA Repeal efforts this afternoon at 2:15pm. This is the first key test vote in the Senate.


The only solid, public vote against the “motion to proceed” (MTP) is Sen. Susan Collins (R-ME). If McConnell holds all his other senators, we would expect the MTP to pass by 51-49 (assuming Sen. John McCain does return to D.C. for the vote). Key conservatives who earlier had indicated they might oppose the MTP now seem to be on board with McConnell. While Sen. Portman (OH) had announced his opposition the most recent repeal/replace public proposal from McConnell, there are growing indications he may support this motion to secure changes related to Medicaid. The Murkowski and Heller votes will be heavily determined by the stance of their governor. (All Democrats will oppose the MTP.)



What happens if the MTP fails?

First, we do want to note that under Senate rules, if this procedural motion appears it will fail, Senate Majority Leader McConnell may switch his vote from supporting the motion to opposing it which gives him the ability to bring the MTP back up another time.


It’s important to note that if the MTP fails, we do not know for sure if McConnell will try again. If they do decide to bring it up again, we are hearing that would not happen before they leave for August recess. It seems very possible that defeating the MTP (or the bill itself if he wins the MTP vote) effectively kills repeal/replace since McConnell and other key Republicans are eager to turn their attention to the FY18 budget and especially tax cuts. We expect to continue to see threats to Medicaid and likely the ACA (within in the context of the budget, for one), but killing this legislation will make it much more difficult for them to bring these threats to bear down the line.


What happens if the MTP passes?

At that point, McConnell most likely will call up the House-passed ACA repeal bill for technical reasons and start amending it. There are 20 hours of debate on the legislation, equally divided among Republicans and Democrats. After that debate is over, we move into “vote-a-rama” in which Senators can get up and offer amendments, which are debated for just a few minutes on each side.


We understand McConnell’s first proposal is likely to be what will be described as “repeal and delay” which is simply repeal without replacement. This proposal is widely expected to be soundly defeated with many Republicans joining Democrats in opposing it.


After that, it appears likely McConnell would bring up his latest CBO-scored repeal and replace proposal and then offer further modifications to it, or allow his fellow Republicans to offer amendments to make changes that will secure their votes.


We would expect, for example, an amendment that would provide $200 billion in funds (which is woefully inadequate) to expansion states to help them provide assistance to those who will lose their Medicaid coverage and have to try to find affordable coverage in the private market.


McConnell may repeat something he did in 2015 when the Senate voted on repeal and delay: after numerous amendments in “vote-a-rama”, McConnell brought a new substitute plan to the Senate floor and jammed it through almost entirely on a party line. McConnell can bring a modified plan to the floor at any point in “vote-a-rama”.


We would not expect a radically different plan, but rather further modifications to repeal/replace that are necessary for McConnell to win the necessary votes for final passage.


Stay tuned...

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