After weeks of uncertainty and an abysmal outlook for success, the Senate Republicans made a small breakthrough today when they passed the motion to proceed to begin debate on the budget reconciliation. The motion passed by the narrowest margin possible: 51-50.
With zero support from the 48 Democratic Senators, the Senate Republicans could only afford to lose two votes. They lost exactly that (Sens. Collins (ME) and Murkowski (AK)), but got the vote they needed via the return of Sen. McCain who was recently diagnosed with brain cancer and the tiebreaking vote of Vice President Mike Pence. It was a monumental effort to merely pass the motion to proceed, and the outlook for a healthcare bill passing the Senate, let alone making it to the President’s desk, is still very much in doubt.
What does the vote mean?
The vote was on a procedural motion known as the “motion to proceed.” The motion to proceed represents the question of whether the Senate should debate the given bill.
Wait, they had to vote to start voting?
Yes, the Senate must first agree to even consider a bill before they can debate, consider amendments, and vote on final passage.
Senate procedures require votes on nearly every motion – including adjournment. Many times, procedural motions are granted by unanimous consent (i.e. no one objects), but partisan tensions and a change in Senate norms have made votes on motions to proceed more usual.
Okay, they agreed to begin considering the bill. What now?
Per the Senate rules used to process reconciliation legislation, the Senate must debate the bill for at least 20 hours prior to final passage. There is also no limit on the number of amendments that can be offered and voted on and the time it takes to vote on amendments can go beyond the required 20 hour time frame.
It has been reported that Majority Leader McConnell will bring up the House passed repeal and replace bill (read here for summary) with a controversial Sen. Cruz amendment that is expected to fail. The Majority Leader will likely also bring up the 2015 repeal only bill, which is also expected to fail.
There will likely be many other politically toxic amendments offered by Democrats that want to make Republicans take uncomfortable votes. It is also possible that Republicans will offer their own ideas on how to improve the health care system. There will also be many points of order raised against provisions that violate the “Byrd rule,” meaning that they are not budgetary in nature and cannot pass as part of a reconciliation bill. It is unclear, but unlikely, that any amendment will have enough support to pass.
Why would Leader McConnell bring up amendments even though he knows they will fail?
To prove to the rank and file members, outside groups, and constituents that certain ideas being pushed by conservatives or moderates do not have the consensus to pass.
Will anything eventually pass?
No, but really?
There are three possible outcomes:
1) During the debate and amendment process, backdoor negotiations continue, provisions are added and subtracted to garner the support of 50 Senators to pass a comprehensive repeal and replace plan that will be voted on as the last amendment in the debate;
2) If a deal on a comprehensive repeal and replace plan cannot be reached, then McConnell will likely offer a “skinny repeal” that will eliminate the individual mandate, the employer mandate, and the medical device tax(an Obamacare provision that is loathed on a bipartisan basis). This is the least-common denominator approach;
What if something does pass?
If something does muster the support of a simple majority, then it will either go back to the House for a vote or it can go to a conference that will have representatives from both the Senate and the House. Using the options above, if a comprehensive repeal and replace passes it will likely go back to the House in hopes that they will pass it as-is and it will go the President’s desk for signature. If the “skinny repeal” option is passed, it will likely go to a conference in hopes that a broader compromise can be reached amongst the conferees that can pass both the House and the Senate.
The motion to proceed was merely a procedural vote. It is still a long shot to get something to pass the Senate – let alone agreed to with the House – and sent to the White House to become law. The procedural vote did nothing to assuage the many concerns among members that caused delay after delay for the Senate Republicans to advance their repeal and replace legislation. In the end, the spectrum of views between the moderates and conservatives in the Republican party will likely be too wide to pass a Republican only health care bill.
However, whether it be a single-party or bipartisan effort, Congress cannot ignore the impact that health care costs will have on the budget and the impact that federal health care spending will have on younger generations moving forward. As we have written before, health care spending is the primary driver of our nation’s budget woes. Medicaid spending is projected to double over the next decade and Medicare is paying out triple the amount it takes in per recipient. We are already $20 trillion in debt and are facing a demographic-driven fiscal crisis with the retirement wave of baby boomers. Wishing these problems away is not a solution. It is a sentencing of younger generations to reduced economic opportunity.
The successful procedural vote was a small win for Senate Republican leadership. The real measure of success will be if Congress can pass a policy that fixes our expensive health care system without relying on future generations to pick up the tab.