115th Congress, Vote 167; Senate #1628

Motion to Proceed on H.R. 1628: American Health Care Act of 2017

Official Title: To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017.

Motion to Proceed on H.R. 1628: American Health Care Act of 2017
Passed by Senate on July 25, 2017, 51-50 (tie broken by Vice President Mike Pence).

Synopsis: The first vote on Tuesday, July 25, was to determine whether H.R.1628, the American Health Care Act (an ACA repeal bill that passed the House in May) would be brought to the floor of the Senate for debate and amendments.

Democrats were universally opposed to the motion, calling instead for a return to a bipartisan, committee-based approach to improving the ACA.

Republicans were mostly in favor of the motion to proceed, although there was considerable hesitation given the fact that it wasn't clear exactly what legislative language would be up for debate if the motion to proceed passed.

There are 52 Republican Senators, and 50 of them supported the motion to proceed. (A motion to proceed needs only a simple majority, which can include a tie-breaking vote from the Vice President.) Among Republicans, only Alaska's Senator Lisa Murkowski and Maine's Senator Susan Collins voted against the motion to proceed. The result was a 50-50 tie, with Vice President Mike Pence casting the tie-breaking vote in favor of the motion to proceed.

As a result, Senate Republicans were able to move forward with 20 hours of debate on H.R.1628, equally divided between Democrats and Republicans. That process began immediately after the passage of the motion to proceed, with amendments put forth to replace the text of the House bill.

Why supporters pushed for this bill

• GOP lawmakers have been calling for ACA repeal for seven years. A successful vote on the motion to proceed helps them gain momentum and continue towards their eventual goal of repealing the ACA.
• Arizona Senator John McCain, who was recovering from a recent craniotomy and facing a glioblastoma diagnosis, returned to DC in order to participate in the GOP health care reform process. He voted in favor of the motion to proceed, as he has long supported repealing and replacing the ACA.
• Notably, however, McCain then gave a 15-minute speech during which he chided the Senate for its partisanship and gridlock, and called for a return to a bipartisan approach to lawmaking. Notably, if McCain had voted against the motion to proceed, his stirring speech would have made a lot more sense; without a successful motion to proceed, Senate Republicans would then have been forced to start over on their approach to health care reform. A failure of their partisan approach would have made a bipartisan approach more likely, but McCain?s support for the motion to proceed resulted in its success.

Why opponents tried to stop the bill

• Democrats support the ACA (although they acknowledge that it needs improvements, and want to work on bipartisan solutions) and do not want to see it repealed. The motion to proceed is on a measure to repeal or drastically change the ACA, which Democrats oppose.
• Alaska GOP Senator Lisa Murkowski opposed the motion to proceed in an effort to "give the Senate another chance to take [the ACA repeal/replace process] to the committee process."
• Maine GOP Senator Susan Collins also opposed the motion to proceed. Collins was the only current Republican Senator who also opposed 2015's H.R.3762 (an ACA repeal-and-delay measure), and has expressed ongoing opposition to the Senate's current ACA repeal process. Her opposition stems from a variety of factors, including the projected loss of coverage for millions of Americans under the various bills that the Senate has proposed, and the drastic funding cuts for Medicaid. To be clear, Collins has been critical of the ACA, and does want to replace it with new legislation. She and Louisiana Senator Bill Cassidy introduced the Patient Freedom Act in January 2017. That bill didn't go anywhere, but it was viewed as a measure that could have gained some bipartisan support.
• An overarching concern is that the motion to proceed will lead to a series of events that will culminate in a conference committee implementing something resembling the American Health Care Act (House bill that passed in May) and the Better Care Reconciliation Act (BCRA, the Senate bill that was introduced in June), or a scaled-down version of ACA repeal that would entirely destabilize the individual market.
• Essentially, it was expected that the Senate would not have the votes for either the current BCRA or for a repeal-and-delay measure (the Obamacare Repeal Reconciliation Act, or ORRA), and would then opt for what's being dubbed a "skinny" repeal. The "skinny" repeal bill would likely eliminate the individual mandate penalty and the employer mandate penalty, along with the medical device tax. But it would leave in place most of the ACA's provisions, including all of the consumer protections that drive up premiums (eg. community rating and guaranteed issue coverage regardless of medical history). On its own, a "skinny" repeal would result in a death spiral in the individual market. But such a bill would have to go through conference committee, where it's expected that lawmakers would go back and add in various aspects from the AHCA and the BCRA. The end result would be millions of additional uninsured Americans, and weakened consumer protections.

07/25/2017

Status: Senate motion to proceed agreed to

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