Health care debate in U.S. Senate: Answering the questions you might have

07/27/2017 11:33 AM

The United States Senate is wrapping up the debate on repealing the Affordable Care Act, and Thursday could be a marathon of votes that may last well into the night.

Below we answer some questions about what has already happened and what could happen in the Senate.

What has already happened in the Senate’s debate on health care?

On Wednesday, the Senate rejected a measure that would repeal major parts of the ACA without replacing it. Seven Republicans joined Democratic members of the Senate in voting ‘no.’

What happens today?

The debate on an ACA repeal is limited to 20 hours under special budget rules laid out in the Budget Act of 1974 (see bottom of page 32).

After debate time runs out, the Senate will start voting on amendments in what is known as a “vote-a-rama.”

Is it really called a vote-a-rama?


What is a vote-a-rama?

Essentially, during a budget resolution, the budget is not subject to filibuster, but all amendments are voted on consecutively without real debate. Since debate is capped at 20 hours and the resolutions can’t be filibustered, offering amendments is the only way opposition can draw out the process.

Each amendment is considered and voted on for about 10 minutes until the Senate is finished with all amendments.

What amendments will they be voting on?

All the amendments have not yet been put forward, but everyone is keeping an eye on what is expected to be the remaining big vote.

The big vote will be on what is being called the “skinny-repeal bill.” What that bill entails is not known.

Speculation for what would be included in a skinny repeal includes:

  • A repeal of the individual and employer mandates
  • A repeal of the taxes on medical device companies
  • Medicaid expansion, subsidies and marketplace regulations stay in place
  • May add funding for opioid crisis

What kind of impact would a skinny repeal have?

The Congressional Budget Office and the Joint Committee on Taxation estimated that repealing mandate penalties and subsidies, while leaving in place market reforms, would result in an increase in the number of people uninsured by 18 million in the first new plan year following enactment of the bill.

Additionally, the CBO and the JCT estimate that premiums in the nongroup market would increase by 20 to 25 percent.


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