In 24 hours, the Senate will vote on a mystery health care bill

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Republican senators are set to vote on a bill to repeal the Affordable Care Act Tuesday. They just don’t know what’s in it.

It’s hard to capture what an absurd and somewhat unbelievable situation this is. Health care is a massive part of the economy. The ACA provides coverage to tens of millions of Americans. The Senate plans to vote on a bill Tuesday affecting all of that. And at this moment — 24 hours or so before they vote — they have no idea what the bill contains.

As we discussed in last week’s VoxCare, there are at least four different draft health care bills floating around right now. There are two that seem most ripe for a vote. These are:

  • The Obamacare Repeal Reconciliation Act (ORRA)This bill would repeal the Affordable Care Act without a replacement. It would have the repeal start in 2020, presumably allowing the Senate two years to come up with a replacement they would enact. But if they didn’t, the consequences would be dire. The Congressional Budget Office estimates that this bill would cause 32 million Americans to lose coverage.
  • The Better Care Reconciliation Act (BCRA)This is the bill that repeals and replaces Obamacare, although the replacement will cover 22 million fewer people by 2026. This bill would repeal the Medicaid expansion and vastly scale back the subsidies middle-income Americans receive in the private market. The BCRA has been through multiple iterations at this point, and we still don’t know what is in the latest version. Late last Friday, we found out that key provisions of the bill — the waiting period to penalize those who decide to go uninsured, for example — would be stripped from the bill for procedural reasons.

The lack of clarity is part of a larger lack of direction for Senate Republicans’ six-month health care effort.

Throughout this process, Republicans have struggled to articulate what exactly they want to achieve — aside from delivering on a seven-year campaign promise to repeal and replace Obamacare.