Senate Republicans Don’t Know What Health Care Bill They’re About To Vote For. That’s Nuts.

Behold the “Something Act of 2017”!

The long, halting slog toward Obamacare repeal is set to reach a significant milestone Tuesday, when the Senate is scheduled to vote on … something.

No, not ”something terrific,” as President Donald Trump promised on the campaign trail. Just … something. The American public will find out what that something is at about the same time as the Republican senators who Majority Leader Mitch McConnell (R-Ky.) wants to amble down to the well of the Senate, raise their index fingers and say, “Yea.”

Tuesday morning, the Senate is scheduled to begin floor debate on whatever that something is. McConnell is asking GOP senators to approve a procedural motion on a House-passed health care bill, which will then allow him to bring up something else, after which senators will debate and vote on amendments to the something.

No one knows what they’ll be voting to debate. Seriously.

In their zeal to repeal the Affordable Care Act, Senate Republicans have neglected to actually figure out what they want to enact in its stead. More than 40 of them have shown no signs they have any problem with this, and the handful who have wrung their hands in public about it have failed to take the crucial next step of actually coming out against it. Sen. Susan Collins (R-Maine) is the lone exception.

The lives of tens of millions of people and the health care system itself are in the hands of senators who are practically flying blind. And all of this is in the service of legislation that violates Trump’s promises of lower premiums, smaller deductibles, and coverage for everyone. What’s more, polling consistently shows that very few Americans actually want Congress to do any of this.

Just days ago, enough Republican senators had declared they wouldn’t vote on this “motion to proceed” that the effort to repeal the central components of the Affordable Care Act and “replace” them with more meager reforms looked like it might be dead. McConnell pulled the hastily assembled Better Care Reconciliation Act.

But the process showed new signs of life because of pressure from Trump and conservative activists and donors. Another key factor is the lack of conviction among those “moderate” senators who had expressed alarm at the legislation’s massive cuts to federal health care programs, especially Medicaid, but don’t want to be known as the Republicans who killed Obamacare repeal.

Nevertheless, it’s not clear whether McConnell has the 50 votes he needs to move forward, especially with Sen. John McCain (R-Ariz) likely unavailable after being diagnosed with brain cancer.

So, what will happen in the Senate this week?

This bill

McConnell could bring up a version of the Better Care Reconciliation Act, his favored Obamacare “replacement.”

This bill would slash federal Medicaid funding by more than one-quarter, severely weaken the Affordable Care Act’s protections for people with pre-existing conditions; shrink financial assistance for people who buy private health insurance and make it available to fewer people; permit health insurance companies to go back to selling skimpy, junk policies that cover fewer things; and increase costs for older, sicker people in order to allow younger, healthier people to buy insurance with even bigger deductibles than found on the Obamacare exchanges.

This bill would increase the number of Americans without health coverage by 22 million, bringing the total to 50 million in 2026, compared to 28 million if the Affordable Care Act were left in place, the Congressional Budget Office reported Thursday.

That bill

Or McConnell could opt to bring up the Obamacare Repeal Reconciliation Act. Unlike the other bill, this one is all repeal and no replace. Congress passed a version of this bill in 2015, and President Barack Obama vetoed it.

The legislation would take away funding for the Affordable Care Act’s Medicaid expansion and the subsidies low- and middle-income families receive for private insurance, and do away with other key aspects of the law. But it wouldn’t attempt to replace them with anything. And it would cause chaos in the health insurance market by leaving in place Affordable Care Act regulations requiring insurers to cover everyone regardless of pre-existing conditions ― but without a mandate that people buy the insurance or help to make it more affordable.

The legislation would increase the number of uninsured by 32 million over 10 years, including 17 million next year alone, and the total would reach 59 million by 2026.

The other bill

And then there’s the House-passed American Health Care Act (which would leave 23 million more uninsured by 2026). Technically, the legislation must serve as the vehicle for whatever the “something” turns out to be because the Constitution requires bills with tax provisions to originate in the House. In these cases, the Senate typically strips these House bills of all their language and substitutes its own bill. Nevertheless, this measure still fits the definition of “something,” and the Senate could do whatever it wants.

What McConnell actually appears to be doing is teeing up a vote for all these bills, should he get 50 Republicans on the initial motion to proceed. In fact, he seems to be using the promise of a vote as the carrot to gain the support of reluctant senators. In essence, he’s saying, “Help me open debate, and you can vote for whichever bill you prefer!”

Somehow, this tactic seems to be working. Sen. Rand Paul (R-Ky.) opposes the Better Care Reconciliation Act, for instance, but may vote to start debate on the Obamacare Repeal Reconciliation Act, as may Sen. Mike Lee (R-Utah), who has been reluctant to back McConnell’s bill. And moderates, afraid of blocking their party from even debating repeal, may follow suit.

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