On July 25, following mounting pressure from President Donald Trump and Senate Majority Leader Mitch McConnell (R-KY), the motion to proceed to consideration of the House-passed budget reconciliation bill to repeal and replace the Affordable Care Act (ACA) narrowly passed the Senate. The motion to proceed to debate on the House-passed American Health Care Act (AHCA, H.R. 1628) passed by a margin of 51-50, with Vice President Michael Pence breaking the tie. Republican Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) voted no on the motion.

Senator John McCain (R-AZ) made a dramatic return to the Senate after his recent cancer diagnosis to vote yes on the procedural vote to begin debate. In his comments, Senator McCain made clear that while he voted to begin debate, he does not support the underlying legislation in its current form. He encouraged a return to bipartisanship and regular order if the current process fails to reach a successful conclusion.

The first amendment under consideration is the Obamacare Repeal Reconciliation Act (ORRA), a full substitute amendment similar to the 2015-passed budget reconciliation bill, which was vetoed by President Obama. If a vote on ORRA fails, it is expected that a version of the Senate's repeal-and-replace legislation, the Better Care Reconciliation Act (BCRA), will be offered as a full substitute amendment. Whether any version of the legislation can garner the support necessary to pass is unclear.

Debate on the reconciliation bill is limited to 20 hours, equally divided between the two parties. Amendments to the legislation may be offered in what is often referred to as a "vote-a-rama," which concludes when there are no further amendments and a vote on final passage is taken.

If both the version similar to the 2015 repeal bill and the Senate's replacement bill fail, a "Skinny bill" repealing the individual and employer mandates and medical device tax is anticipated. If any version is able to pass, Senate and House Republicans could work through a conference committee to find a compromise that can pass the House and the Senate.

View the latest version of the bill.

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