The Senate moved forward on health reform Monday when it approved a motion to proceed (51-50, Vice President Pence cast the deciding vote) but what does that mean?

The motion allows the Senate to debate health care reform for 20 hours before voting on amendments to the House bill (American Health Care Act). The amendments can be completely new bills, and that’s what the last two votes this week have been regarding: the Senate’s Better Care Reconciliation Act (BCRA) and a measure that had been previously introduced in the last session as a straight repeal measure. Both of these bills failed to pass by a significant margin. There was also an issue raised by the Senate Parliamentarian, who hasn’t approved all of the provisions in the BCRA for use in the reconciliation process.

This morning, the Senate narrowly rejected what's being called the 'skinny repeal.' Senators voted 49-51 for the bill, falling two votes shy of votes needed to pass the legislation. 

What is reconciliation?

Reconciliation is a legislative process that allows the Senate and House to expedite certain budget related legislation on spending, revenues, and the federal debt limit with a simple majority vote (51 and 218 votes in the Senate and House respectively). This process imposes a 20 hour cap on the total time for debate, motion, and amendments related to reconciliation bills. Reconciliation bills are limited to only spending, revenues and the federal debt limit. If larger policy changes that are extraneous to the budget are introduced then a bill would be subject to filibuster and would require a minimum of 60 votes in the Senate to overcome a filibuster (known as invoking cloture).

The Republicans, holding 52 seats, wish to take advantage of the reconciliation process in order to pass health reform legislation as they don’t have a 60 vote block to avoid any Democratic filibuster. In order to do this, the Republican bills must be limited to revenue provisions in the Affordable Care Act (such as the employer mandate and individual mandate penalties). The Parliamentarian has raised some concerns with several provisions under the current drafts, including the defunding of Planned Parenthood, may be considered improper, larger policy issues that aren’t able to be included in a reconciliation measure.

With Republicans unable to come to a consensus bill, you may wonder what’s going on. The strategy is, as described by HHS Secretary Tom Price, to “figure out what the lowest common denominator is — what gets us to 50 votes so that we can move forward on a health care reform legislation.” The bill, any bill that passes the Senate, would then go to the House for more debate and amendments, likely creating a much different final measure that would be returned to the Senate for consideration.

So, if anything does move forward, it’s still a long, long way to #repealandreplace.

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