Senate clears lowest hurdle to start ACA repeal and replace debate but health bill strategy relies on surprise (Updated)

This post has been updated since a subsequent Senate vote on amendments to the repeal and replace bill held late last night.

Although Republicans prevailed with a procedural vote today to debate a health bill shrouded in mystery, it took all hands on deck just to do that much.

Arizona Republican Sen. John McCain, recently diagnosed with brain cancer, flew back to DC to add his yes vote to the mix, earning him rare praise from Trump as a “hero”, which diverted from his famous diss of the man.

So great that John McCain is coming back to vote. Brave – American hero! Thank you John.

— Donald J. Trump (@realDonaldTrump) July 25, 2017

McCain was joined by fellow Republicans Sens. Shelley Capito from West Virginia and Dean Heller from Nevada, both of whom have expressed concern about the impact of repeal and replace on their states’ residents dependent on Medicaid. The vote was a squeaker, with Vice President Mike Pence forced to break a tie.

Things are so chaotic on Capitol Hill it’s hard to think of the most appropriate metaphor. Game of Thrones seems to be popular, while Axios Vitals amusingly observed in its newsletter that the uncertainty on Capitol Hill feels more like a traffic light with a strobe light effect.

It’s impossible to overstate how incredible this is: The Senate is planning to vote today to begin debate on a health care bill, but no one knows which one.

The consensus of the speculation around which version of the repeal and replace bill will be the subject of the Senate debate is that it will be a slimmer and less ambitious than Senate Majority Leader Mitch McConnell’s previous efforts but still has the power to undermine ACA without doing much to help it. It would do away with the individual and employer mandates (for companies employing more than 50) requiring them to buy insurance which risks causing further disruption to the insurance industry.

It’s a puzzling way to start a debate by providing a black box of legislation to vote on. How can one argue intelligently on something without knowing the contents? It seems like bizarre logic to reason that because limited transparency resulted in failure before that the element of surprise is a sound strategy, especially when the healthcare of so many is at stake.

McCain had a sardonic take on the situation in a statement on the Senate floor:

We’ve tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them it’s better than nothing, asking us to swallow our doubts and force it past a unified opposition. I don’t think that is going to work in the end. And it probably shouldn’t.

The Obama administration and congressional Democrats shouldn’t have forced through Congress without any opposition support a social and economic change as massive as Obamacare. And we shouldn’t do the same with ours.

But repeal and replace isn’t for wimps — if you blink you’ll miss something, like another failed vote. Last night the Senators voted on a two-pronged amendment to the Better Care Reconciliation Act. One from Texas Republican Ted Cruz would have permitted insurers to sell health plans stripped of benefits required by ACA such as maternity care so long as they sell other plans that include these benefits, according to The New York Times. Ohio Republican Rob Portman led an amendment to support out-of-pocket medical costs for low-income people, including those who buy private insurance, presumably after both houses of Congress vote to take away their Medicaid coverage.

But nine Republicans voted 43-57 against the measures which sought to appeal to moderates and hardliners in the Republican party.

The next vote will be this afternoon — a straight up repeal of ACA, according to Axios Vitals, but it isn’t expected to pass.