Senate Votes To Proceed On Health Care Bill That Doesn’t Exist Yet

In a vote close enough to require the Vice-President to cast a tie-breaking vote, the Senate voted to proceed to debate on a health care bill even though nobody seems to know what bill they'll ultimately be voting on.


With Vice-President Pence casting the tie-breaking vote, the Senate voted this afternoon to proceed forward with debate on a health care reform bill without knowing which bill they’d be debating:

WASHINGTON — The Senate narrowly voted on Tuesday to begin debate on a bill to repeal major provisions of the Affordable Care Act, taking a pivotal step forward after the dramatic return of Senator John McCain, who cast a crucial vote despite his diagnosis of brain cancer.

Vice President Mike Pence cast the tie-breaking vote.

The 51-50 vote came only a week after the Republican effort to dismantle a pillar of former President Barack Obama’s legacy appeared all but doomed. It marked an initial win for President Trump, who pushed, cajoled and threatened senators over the last days to at least begin debating the repeal of the health care law.

But even with that successful step, it is unclear whether Republicans will have the votes they need to uproot the law that has provided health insurance to millions of Americans. The Senate will now begin debating, amending and ultimately voting in the coming days on legislation that would have a profound impact on the American health care system.

By a single vote, the Senate cleared the way for an epic battle over the future of the health law. Only two Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, voted against the motion. The debate has broad implications for health care and households in every state.

Senate Republican leaders have struggled all year to fulfill their promise of repealing the 2010 health care law, and the procedural vote in the Senate on Tuesday risked being another big setback for the party. The House narrowly approved a repeal bill in early May, but only after Republicans overcame their own difficulties in that chamber.

President Trump kept up the pressure on Tuesday by posting on Twitter. “After 7 years of talking,” he said, “we will soon see whether or not Republicans are willing to step up to the plate!”

The successful procedural vote on Tuesday is an important step forward for the Senate majority leader, Mitch McConnell of Kentucky, who only a week ago appeared to have failed in his effort to put together a health bill that could squeak through the narrowly divided Senate.

That said, it remained far from certain whether Republicans would actually be able to agree on a bill in the days to come — and what exactly the contents of that bill would be.

Perhaps the most dramatic moment of this afternoon’s vote came at the end, when Senator John McCain, who just last week was revealed to have brain cancer after undergoing surgery some two weeks ago, arrived after landing at Reagan National Airport to come to Washington to participate in the vote. In the end, McCain ended up voting in favor of the Motion To Proceed, a vote which proved to be crucial given the fact that two Republican Senators, Susan Collins and Lisa Murkowski, had voted with the Democratic caucus and the Senate’s two Independents to block the bill from proceeding. This left the bill at a 50-50 tie, and it was left to Vice-President Pence to cast the tie-breaking vote so that the Senate could proceed to debate on the bill and a final vote that could come as early as the end of this week, this weekend, or early next week. McCain’s return after his diagnosis was marked by a bipartisan standing ovation that lasted for several minutes. After the vote was over, McCain spoke for several minutes from the Senate floor, although he did not make direct reference to his health. Somewhat ironically, though, McCain did call on his fellow Senators about the need to return to “regular order” in the consideration of legislation. It’s worth noting that this call for regular order came just minutes after McCain himself voted to proceed with final debate on a bill on which there have been no Committee hearings or other public debate that would ordinarily take place in the consideration of proposed legislation.

Going forward from here, the Senate will proceed on a rather expedited basis to consider this matter even though we still don’t know what bill will be voted on when the final vote is held in the coming days. As The New York Times explained in an article posted earlier today, the procedure from here is the process under which that final bill will take shape. First, there will be roughly twenty hours of debate on the floor equally divided between Republicans and Democrats on the bill, a debate that should be interesting, to say the least given the fact that nobody seems to know which version of health care reform they’ll ultimately be voting on. After that debate is over, the Senate will proceed to consider amendments from both sides of the aisle, many of which would replace the original bill in its entirety and others which would add or remove only certain provisions. There’s no word right now on how many Amendments the Senate will consider, but each one will have to be subject to its own roll call vote, which could lead to another one of the all-night “Vote-A-Rama” sessions that we’ve seen from the Senate in the past. At any point in this process, any Senator would be free to raise a point of order to the overall bill or one of the Amendments. The main intention of this process would be to either prevent the bill from being considered under the Senate’s reconciliation rules, which would make final passage more difficult or to delay the process as long as possible. After each of those points of order and amendments is considered, Majority Leader MitchMcConnell will propose a Final Amendment that would essentially end up being the final bill. The Senate would vote on this amendment, and then, if it passes, on the final version of the bill.

Officially, the bill that the Senate voted to proceed to debate on is the American Health Care Act that the House narrowly voted to pass in early May, though it’s unlikely that this bill will make it through the week unscathed. Instead, Republicans will apparently be proposing a number of amendments including everything from the revised version of the Better Care Reconciliation Act, which was pulled from the floor earlier this month due to the fact that it lacked sufficient to pass even under reconciliation, the repeal-only bill that Senator McConnell proposed last week, which was never put on the floor for largely the same reasons, and a version of the repeal bill called “skinny repeal” that would only repeal certain provisions of the Affordable Care Act such as the individual and employer-provided coverage mandates. This final idea is something that is just being discussed now and would be meant to give Senate Republicans something they could pass that would move the process forward. Presuming the Senate is able to pass something, that bill would either go to the House for consideration or become the basis for the Senate and House entering into an agreement to form a Conference Committee that would try to hammer out a bill that would pass both chambers.

At this point, it’s hard to say exactly what’s going to happen. Since we don’t know what the Senate will ultimately be voting on, using the outcome of today’s roll call vote to predict the outcome of a final vote would be mistaken. Given how things have proceeded in the Senate over the past two months, it’s entirely possible that the final bill could end up losing the support of at least one more Republican Senator, which would be enough to kill the reform effort overall, or it could result in the passage of a bill that can’t pass the House for one reason or another. Things would become additionally complicated if Congress proceeds with the Conference Committee process since it could be several weeks if not longer before we see final votes in the House and Senate on a bill that could conceivably make it to the President’s desk. As it stands, though, the fact that the Senate was able to pass this procedural hurdle makes it more likely that it will be able to pass something, and more likely that Republicans will ultimately succeed in their seven-year quest to ‘repeal and replace’ the Affordable Care Act. As things stand right now, though, the Senate and House will have to vote on a bill before we find out what’s in it.

FILED UNDER: Congress, Healthcare Policy, US Politics, , , , , , , , , , , , , , , , ,
Doug Mataconis
About Doug Mataconis
Doug Mataconis held a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010 and contributed a staggering 16,483 posts before his retirement in January 2020. He passed far too young in July 2021.


  1. Moosebreath says:

    Republicans for years used an attack ad distorting Nancy Pelosi’s line that we need to vote on the bill to know what is in it. However, given the chance, they do exactly what they falsely accused the Democrats of doing. You cannot make this up.

  2. al-Ameda says:

    What a surprise, even Heller, who was oh so concerned about the people of Nevada, caved in. And look, so-called maverick John McCain caved in too.

    I’m completely shocked.

    Full Disclosure: I just won 2 office bets that this is exactly what would happen, that all but 2 Republicans would cave in, and Pence would break a tie.

  3. Senyordave says:

    The only thing that matters to most of the republicans is that the ACA disappear and the Koch brothers, Adelson. et. al get what they paid for: a huge tax cut to the 1%. A side benefit is that millions will lose their insurance. My guess is that they will try to cobble something together that will:

    1. Cut taxes for the wealthy
    2. Put back some things that are tailored towards “deserving poor” (white people) while maximizing pain for POC
    3. Have a big delay and kick the can down the road as much as possible

  4. teve tory says:

    John McCain may have done something heroic 40+ years ago, but he’s been a shithead for decades.

  5. Senyordave says:

    @teve tory: A large part of his legacy will Sarah Palin. He helped the GOP normalize a reverence for ignorance that culminated in Trump, an ignorant, racist buffoon.

  6. teve tory says:

    I Don’t Want To Hear Another Fucking Word About John McCain Unless He Dies Or Actually Does Something Useful For Once

    Alex Pareene
    2/17/17 4:19pm

    John McCain—the original Maverick, ol’ Walnuts, the brave teller of truths—is somehow once again positioning himself, to credulous journalists, as a renegade Republican who isn’t afraid to buck his party, despite his three-decade record of not ever actually bucking his party in any meaningful way.


  7. An Interested Party says:

    This sick joke of a process makes “We have to pass the bill so that you can find out what is in it” look like pearls of wisdom by comparison…

  8. HarvardLaw92 says:

    Now cometh the legion of politically embarrassing amendments submitted by Democrats, all of which the Senate will have to vote on and all of which will subsequently be hung around GOP senatorial necks.

    Let the games begin. I honestly thought that McConnell was better at this.

  9. Tyrell says:

    Somebody needs to do something soon. The whole thing is falling in. Seems like every week another insurance company pulls out of the markets. Most states can’t afford their own plan.
    Soon about the only company left will be Plumber’s Groove Health and Accident Insurance Company (see Sunday newspaper ad, right below the “Dog Almost Itches To Death” ad; page 17m.)

  10. Not the IT Dept. says:

    One of those amendments had better be the ending of healthcare plans for Congress critters in both houses. Let them pay out of pocket or die in a cardboard box under a bridge: makes no difference to me. They should not get a better deal than the poorest American in their states.

  11. Tyrell says:

    @Not the IT Dept.: I will drink one on that note.
    “Insurance ? I’ve never been insured in my life. There’s no risk.”
    “He who has the ability to survive”
    (Lewis, “Deliverance” Burt Reynold’s greatest performance; the movie that put white water trips on the map)

  12. Mikey says:


    And look, so-called maverick John McCain caved in too.

    Seen on Twitter: “Senator John McCain Venn Diagram” which is two circles, labeled “words” and “actions,” that do not overlap.

  13. Daryl's other brother Darryl says:

    Chances are if you call yourself a maverick, you ain’t one.
    John McCain is really just a sad pathetic little boy…kissing Donnie’s fat lily-white arse…

  14. Neil Hudelson says:


    see Sunday newspaper ad

    Ha. Adorable.

  15. Daryl's other brother Darryl says:

    John McCain…fresh off free, government provided surgery…votes to deny insurance to millions.
    Very maverick-y.

  16. rodney dill says:

    My whole world lies waiting behind door number three.

  17. James Pearce says:

    It marked an initial win for President Trump, who pushed, cajoled and threatened senators over the last days to at least begin debating the repeal of the health care law.

    It’s become a bit of a joke to say “This is why Trump won” whenever you encounter some absurdity or another.

    But this –the pushing, the cajoling, and the threatening– is why Trump won.

  18. al-Ameda says:


    Somebody needs to do something soon. The whole thing is falling in. Seems like every week another insurance company pulls out of the markets. Most states can’t afford their own plan.

    LO ‘effing L
    Perhaps you did not get the #RealNews? Republicans have been methodically undoing (sabotaging) ‘Obamacare’ since Trump was installed as president – reducing subsidies and so forth.

  19. al-Ameda says:

    @James Pearce:

    But this –the pushing, the cajoling, and the threatening– is why Trump won.

    Well that explains why ‘maverick’ John McCain caved in.

  20. Daryl's other brother Darryl says:

    Tyrell is one of the fools who voted for Dumb Don because he thought he would make his life better.

  21. Daryl's other brother Darryl says:

    President Snowflake in June 2016:

    Thank you to the LGBT community! I will fight for you while Hillary brings in more people that will threaten your freedoms and beliefs.

    President Snowflake, today:

    After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow……….Transgender individuals to serve in any capacity in the U.S. Military. Our military must be focused on decisive and overwhelming………victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you

    A 2016 Rand study found that LGBT service had…

    “little or no impact on unit cohesion, operational effectiveness, or readiness.”

  22. Daryl's other brother Darryl says:

    @Daryl’s other brother Darryl:
    Remember Trumps 5 military service deferments…good times.

  23. Kylopod says:

    @Daryl’s other brother Darryl: This is just one more piece indicating that anyone who supported Trump in the belief that he’d govern to the left of a typical Republican has been played for a fool. From trade to infrastructure to health care to Medicaid, and now this.

  24. Mister Bluster says:

    Trump should ban sexual perverts that molest women from serving in the military.
    Then he would have to resign as Commander in Chief.

  25. James Pearce says:


    Well that explains why ‘maverick’ John McCain caved in.

    But it doesn’t explain why McCain is still considered a maverick.

    (I mean, he “caved?” I never mistook him for an O-care supporter.)

  26. Moosebreath says:

    @James Pearce:

    “But this –the pushing, the cajoling, and the threatening– is why Trump won.”

    And this differs from any other major party candidate for President in our lifetime (except maybe Jimmy Carter) because…?

  27. Kylopod says:

    @James Pearce:

    I mean, he “caved?” I never mistook him for an O-care supporter.

    It reminds me of the John Oliver piece in which he showed a reporter speculating that Ivanka differed from her father on climate change, immigration, gay rights, and a range of other issues despite there being absolutely zero evidence for this assumption. Whenever someone gets an unearned reputation for reasonableness, people start mindlessly projecting their own views onto the person. It’s a PR technique that both Ivanka and McCain excel at.

  28. James Pearce says:


    And this differs from any other major party candidate for President in our lifetime (except maybe Jimmy Carter) because…?

    Trump is cut from the same presidential cloth as all of our other candidates? There’s nothing unusual or disruptive or “off” about him?

  29. al-Ameda says:

    @James Pearce:

    (I mean, he “caved?” I never mistook him for an O-care supporter.)

    Well, given that he is routinely referred to as ‘Maverick Senator John McCain’, yeah, I’m surprised that he caved in to a president that mocks him, and supported “debate” on a Republicans-Only bill that has been scored as having the potential to create millions more uninsured and reduce medical services to millions of under-served Americans, many in rural areas.

    And you don’t have to be a fan of ‘Obamacare’) to recognize that going with the GOP flow will do nothing to improve health insurance or health care outcomes.

    But if your preference is to undo a somewhat successful socialized program intended to reduce the number of uninsured and reach under-served populations, then I understand it.

  30. Moosebreath says:

    @James Pearce:

    There are lots of ways Trump is different than other candidates. This is not one of them, as it is something which is a core competency of a politician.

  31. grumpy realist says:

    Looks like after all that sound and fury the whole situation has reverted back to Ground Zero, a.k.a. “What will we do now?”

  32. Kylopod says:

    @grumpy realist: I’ll believe it when I see it. Every time the bill is declared dead, the Republicans just keep moving it along. And it really doesn’t reassure me that some of the loudest complaints are coming from senators like McCain and Graham who so far haven’t shown any inclination to put their money where their mouth is. For example:

    “I cannot tolerate our skinny bill being the final answer on health care,” Graham said. “No way. If you passed it as a standalone proposition it would destroy the insurance markets and we would own the failure of Obamacare. I’m a ‘no’ if it’s not allowed in conference.”

    To yank away Obamacare and allow one sixth of the U.S. economy collapse, to deny millions of people coverage and for the Republican Party to own the resultant disaster, Graham said, would be “the dumbest thing in history.”

    This is the same guy who just voted for the repeal-only bill.