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The 7 steps ahead for Senate Republicans to pass their health care bill

Vox.com logo Vox.com 7/17/2017 Dylan Scott

In this July 13, 2017 file photo, Senate Majority Leader Mitch McConnell of Ky. walks to his office on Capitol Hill in Washington. Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups. © AP Photo/Pablo Martinez Monsivais, File In this July 13, 2017 file photo, Senate Majority Leader Mitch McConnell of Ky. walks to his office on Capitol Hill in Washington. Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups.

Senate Republican leaders are pushing ahead for a vote soon on their contentious plan to repeal and replace Obamacare.

The bill already looks to be in grave danger: Senate Majority Leader Mitch McConnell needs 50 of the 52 Senate Republicans to back the plan, under the special procedural rules Republicans are using to pass the bill with a bare majority and avoid a Democratic filibuster. Two Republican senators, Susan Collins of Maine and Rand Paul of Kentucky, have said they’ll block the vote to start debate on the bill. One more defector would kill it.

Leadership’s plans for a vote this week were thwarted when Sen. John McCain (R-AZ) had emergency surgery to remove a blood clot. McConnell has delayed the health care vote until McCain returns, because without him, they don’t have the votes to advance the legislation.

McConnell has already put the House health care bill on the Senate’s calendar, so he can move fast once he decides to. Under the “budget reconciliation” rules Senate Republicans are employing to advance the bill with just 50 votes, they will start on the House bill before eventually swapping it out for the Senate bill they have been working on for the past two months.

Here’s what will happen.

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1) McConnell will make a motion to start debate on the House bill. That step — known as the motion to proceed — will require 51 votes. Vice President Mike Pence can break a 50-50 tie.

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2) The Senate will debate the House legislation on the floor for 20 hours, with that time divided evenly between Republicans and Democrats. That’s 20 hours of debate time, not real time, so the debate could last a couple of days.

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3) At the end of the debate, there will be a “vote-a-rama,” during which senators can offer an unlimited number of amendments to the bill. Amendments that are considered “germane” to the health care legislation need 51 votes to be added to the bill.

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4) At some point, either during debate or after the vote-a-rama, McConnell will offer his own Senate bill as a substitute for the House bill. The timing will depend on whether McConnell wants the amendments brought up during vote-a-rama to be added to the final bill or not. This will be a key decision: If McConnell waits until the end to introduce his substitute, then none of the amendments that were added during vote-a-rama will actually be part of the final legislation.

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5) The Senate will take a final vote on passage of the Senate bill. That will require 51 votes. Pence can break a 50-50 tie.

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6) If the Senate passes the bill, the House will probably take it up and pass it as is. The other option would be for the two chambers to negotiate a new plan, but most people in Washington expect the House to simply approve the Senate bill. A bare majority, 218 members, must vote for the bill for it to pass.

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7) Once both chambers pass the health care legislation, President Trump will sign it into law.

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