Senate Republicans just took a big step toward Obamacare repeal

Obamacare repeal just took a big step forward. Shortly after 1 am Thursday morning, the Senate voted 51 to 48 along party lines to approve the budget that Republicans want to use to repeal the health care law.

It’s bad news for Obamacare supporters and the 20 million people who rely on it for insurance. But it’s also the first (relatively simple, politically) step in a process to actually repeal the law.

Earlier this week, a group of moderate Republicans — led by Tennessee Sen. Bob Corker — had proposed delaying the budget to give the GOP more time to figure out its replacement package. But those swing-state senators withdrew their objection late last night, removing a key barrier for repeal to move forward.

Politico’s Dan Diamond has a timeline of the basic steps still remaining for repeal to pass: (You can read more about the mechanics of repeal in this explainer by Vox’s Sarah Kliff.)

So Obamacare’s demise is far from sealed. But last night was not a good sign for those hoping the ACA survives — in part because Senate Republicans got a lot closer to repeal, and in part because they also defeated several dozen proposals by Democrats intended to lighten the blow of Obamacare repeal on the health care system.

The unpopular votes Republicans took

A quirk in the budget process gave Democrats the rare opportunity Wednesday to offer a flood of amendments on which Republicans would have to vote. More than 100 were submitted, creating an unusual seven-hour session on the Senate floor — dubbed “vote-a-rama” in Capitol Hill parlance — on legislation often explicitly designed to force Republicans to take unpopular stances.

Here are some of the proposals put forward by Democratic senators that were defeated last night:

• Allowing 26-year-olds to stay on their insurance: Wisconsin Sen. Tammy Baldwin proposed an amendment aimed at protecting the Obamacare provision ensuring that young adults up to 26 could stay on their parents’ plan.
• Lowering prescription drug costs: Sens. Bernie Sanders and Amy Klobuchar advanced a plan that would have legalized the importation of pharmaceuticals from Canada in an attempt to drive down drug prices.
• Protecting women’s health amendment: New York Sen. Kirsten Gillibrand proposed an amendment to protect the ACA provisions related to combating gender discrimination, including a measure that ensures women aren’t charged more for their insurance than men because of their gender.
• Ensuring rural hospitals stay open: West Virginia Sen. Joe Manchin had an amendment geared toward preventing rural hospitals and health care providers from being weakened under repeal. That failed.
• Preexisting condition guarantee: Pennsylvania Sen. Bob Casey also advocated for an amendment that would have prevented ACA repeal from eliminating the law’s protections for those with preexisting conditions.

After all of these amendments (and others) were defeated, the Republican senators held a final vote count for advancing the budget. It made for a dramatic finish on the Senate floor, as each Democratic senator voiced his or her reason for opposing ACA repeal often before being cut off by presiding officer Republican Sen. Cory Gardner, the presiding officer.

Obamacare repeal is looking for real

On the one hand, there may be some narrow good political news here for Democrats. The votes their Republican colleagues took last night may wind up toxic in purple states — keeping young people on their parents’ plans and lowering prescription drug costs, for instance, are both popular issues Democrats will be eager to run on in 2018.

But the more important story here is that Republicans hinted at their willingness to come together and stay unified to make Obamacare repeal a reality. Just two days ago, New York magazine’s Jonathan Chait used the Corker group’s threat of a defection to conclude that, “Obamacare repeal may have just died.”

It’s looking awfully alive Thursday morning. Not only did Republicans successfully advance the budget that will be used to dismantle Obamacare — they also did so while also taking very risky votes for their careers, and almost always with the full support of their caucus.

For Senate Democrats, that dynamic simply amplifies the necessity of hanging together — and, they say, makes their job as defenders of the Affordable Care Act that much more vital.

“We can’t underestimate the importance of our role here,” Hawaii Sen. Brian Schatz told me in an interview in the Capitol on Wednesday afternoon. “We have to feel the desperation that is out there and internalize what’s going on in people’s lives — people are really fearful for what’s going to happen to this country. We need to feel as desperate as the people we represent.”