As you probably know by now, on Tuesday afternoon, the Senate took up the “Motion to Proceed” to start debate on the health care bill. Technically the motion to proceed was on the House passed bill, which while unpopular was able to garner 50 votes allowing Vice President Pence to offer the 51st vote needed for the motion to succeed. If you thought the last few weeks of the health care debate were crazy, just wait. The real action has only just begun. Given that fact, we thought now might be a good time to offer a quick tutorial on the anticipated process as well as explanations regarding some of the terminology that you are undoubtedly encountering. That said, please keep in mind that this is a moment to moment process and just about anything can happen.
With the motion to proceed complete, the Senate has now engaged in 20 hours of required debate split evenly between both parties. During this 20-hour phase, Senator McConnell has offered a variety of amendments that will be discussed and voted on. For example, the repeal and replace bill, the Better Care Reconciliation Act (BCRA) has already been offered and voted down. Next, the full repeal was offered and also voted down. If you are confused about the fact that this period is referred to as a “debate,” but it also includes votes, you are not alone. Hold on, and we will try to explain.
Following these next 20 hours (of debate, amendments, and votes) Senator McConnell will call for a FINAL vote on a bill. At this point, it is anticipated that it will be a smaller bill that still meets the requirements of reconciliation (more on that below). This final vote then kicks off a process referred to as “vote-a-rama” which is a period during which Senators can file as many amendments as they like although to be offered they must be germane to the bill and have a fiscal note (or cost). Leadership from both parties will decide which amendments will be offered and they will often be presented in blocks with 5 minutes of debate given to both sides before a vote is called. This process can take as long as Leadership allows and therefore can be done quickly by limiting the amendments or used as a delay tactic while further negotiations are underway.
However, as promised, there are many other ways in which this next phase could play out, so we will try to cover some of those as well. First of all, as for the substance of the bill that McConnell will call for a final vote on, it is projected to be what is deemed the “skinny bill.” This is a short bill that only repeals the individual and employer mandates and the medical device tax – a bill that could potentially garner 50 Republican votes. The point of moving this would not necessarily be to sign this smaller bill into law – but instead to use this bill as a vehicle to move into yet another phase of the process called a conference committee. That said, an outside possibility remains that the House could take up the skinny bill before leaving for recess next week and both chambers would then look to other opportunities through which to pass broader reform.
However, at the moment, it remains more likely that a conference committee will be required. This committee is developed after both chambers have passed a bill, but the bills are not identical. The conference committee is where each chamber will negotiate for their priorities, and if a compromise bill can be reached, each chamber will vote on the conference report (the new bill) and then send it to the President's desk. Being appointed to a conference committee is quite prestigious, and it is believed that some Senators have been won over by the promise of a place on the conference committee.
Why would a strategy be to get to conference? Because in conference, Members of Congress can craft any bill they would like, it transpires behind closed doors. Additionally, if a bill is successfully negotiated during this process, that bill returns to each chamber with fast-track protections, limited debate, and no amendments.
Still confused? Everyone is! As stated above, this is a very complex, fast moving process with various priorities and strategies at play. We have not even talked about if/how reconciliation, a congressional budget score, the “Byrd Rule” among other parliamentarian rules could play a part in any of these steps. Much remains to be seen, but hopefully, this blog has offered some helpful information on what we expect to happen and a bit of insight into what is also possible.