Here’s a recap of what happened yesterday and what “may” be next (always subject to change).

 

Debate occurred for most of the day, starting around 9:30am. As of now, about 10 hours of debate are left till vote-a-rama (though both sides could yield back time if they’d like). And Sen. Cornyn admitted the skinny bill is a bait-and-switch to get to conference (see links to his statements below).

 

Finally in mid-afternoon we got to votes. First up was the “straight” repeal bill (based on the 2015 reconciliation bill passed by the House and Senate and vetoed by Obama). This would have repealed most of the ACA without an immediate replacement and was what got Sen. Paul to agree to vote “yes” on the Motion to Proceed. That vote failed 45-55 (7 Republicans joined all Democrats, vote tracker here).

Then Senator Donnelly (D-IN) proposed a motion to send the bill back to committee to eliminate provisions that reduce or eliminate benefits for current Medicaid beneficiaries and that prevent states from expanding coverage. That vote failed on a party line vote, 48-52. A similar motion by Senator Casey (D-PA) to refer back to committee to eliminate provisions that negatively impact people with disabilities failed, as did an amendment by Sen. Heller (R-NV) – a “Sense of Senate” that Medicaid expansion is a priority and that Obamacare must be improved.

The Republican Caucus is currently meeting to determine its next steps. Possibilities include a series of amendments by Sen. McCain to make modest changes to the Medicaid provisions (including adjusting FMAP for newly eligible Medicaid enrollees in pre-expansion states; adjusting the growth rate in Medicaid per capita caps). For more information on these and all amendments, see an amendment tracker here and vote tracker here. 

Also likely up for a vote today is the Graham-Cassidy bill (no leg language is available yet, a CNN article on the proposal is here). If Graham-Cassidy is offered as an amendment to AHCA rather than a comprehensive substitute, a CBO score isn’t needed.

It’s possible we could start vote-a-rama today. While technically about 10 hours of debate are left, Senators can yield back the time to move the process along. If that happens, the “skinny” bill could come up Thursday night – it is expected to be a “king of the Hill” amendment submitted as the very last amendment by Sen. McConnell in vote-a-rama (his prerogative as Majority Leader) and becomes the last standing bill if it passes.

Targets still include the usual suspects (in no particular order) -- Collins, Murkowski, Heller, McCain, Capito, Portman, Moran. Message – no on “skinny” bill or any bill that allows Republicans to go to conference committee; no to repealing Medicaid and no to messing with Medicaid.

A few resources from today:

·         Sen. John Cornyn’s statement that  the so-called skinny bill is a bait and switch to get to Medicaid cuts in Conference:  

o   http://thehill.com/policy/healthcare/343896-gop-leader-senate-could-pass-scaled-down-obamacare-repeal: "We use the template of the House bill that addresses all of these issues and come up with the best of the ideas we've developed, like the Cruz freedom amendment and the Portman negotiation on Medicaid and the wraparound, and all those would be live and could be used as part of a deal in the conference committee," Cornyn said. 

o   https://twitter.com/MEPFuller/status/890294301552521217 -- Cornyn on if Medicaid will be in skinny: "No, I think people understand we'll address the Medicaid issue when we conference with the House."

·         AMA statement that eliminating the individual and employer mandates will exacerbate current affordability problems and destabilize the individual market.  https://www.ama-assn.org/ama-statement-senate-debate-health-system-reform