Early Thursday morning, the Senate passed a measure that is the first step in repealing the Affordable Care Act, or "Obamacare."
The nonbinding budget measure, which passed 51-48, will make it easier for future legislation to repeal President Barack Obama’s signature health care law.
The 2010 law set up exchanges to sell health care polices to millions of Americans who could not get health care insurance because of pre-existing conditions or because they could not afford it. The legislation also poured billions of dollars into states’ Medicaid programs for the poor.
In the past two years, many major insurance companies have pulled out of the exchanges, because they claim they lost too much money paying claims without bringing in enough new, healthy payers to make up a profit.
The House is expected to vote on the measure Friday. While Republicans hold the majority there, some GOP members have said they want to see a plan to replace the ACA before they vote to repeal it.
Here’s a look at the process to dismantle Obamacare that began with the vote early Thursday:
Why is the vote significant?
Thursday's Senate vote was a procedural one. No law was passed. What was passed was a budget resolution bill. Included in that legislation was a procedure that set up special rules that will allow a bill to repeal the Affordable Care Act to move forward. The procedure is known as reconciliation.
The rules will let portions of a bill to repeal the ACA to move forward with only a simple majority vote in the Senate. That means that instead of requiring 60 votes to move legislation, it will take only 51 votes.
There are 52 Republicans in the Senate this term.
Wednesday’s vote was one to begin debating a 2017 budget. That is the first step in repealing the ACA.
What does reconciliation do?
Under reconciliation, certain legislation cannot be held up by a filibuster, a delaying tactic used to block legislation or procedural votes. A filibuster can happen when a senator is recognized to speak on the Senate floor. He or she may speak as long as they wish, potentially holding up a vote on legislation.
It takes a motion known as cloture to end a filibuster.
A cloture motion requires a three-fifths majority (60 votes out of the 100 votes in the Senate) to end a filibuster. First, however, 16 senators must present the motion, then a day must pass before the motion is considered. If the motion passes – that is 60 senators vote to end a filibuster – 30 more hours of debate is still allowed.
Democrats used reconciliation in part to get the Affordable Care Act passed in 2010.
Does reconciliation works with all legislation?
Reconciliation is only allowed with budget issues, legislation that has to do with federal spending or taxes. Reconciliation bills are not subject to a filibuster in the Senate. Debate is limited to 20 hours under Senate rules.
So the repeal of the ACA is a done deal now?
No, it isn’t, and here is why. To replace the ACA requires legislative action that has nothing to do with the budgeting process.
Much of the replacement of the law would take place outside of the reconciliation process. Since it would be outside of the that process, it would be subject to filibusters, thus Republicans would need Democratic votes to get over the 60-vote filibuster threshold. (Remember, there are only 52 Republican Senate members).
What’s the next step?
On Friday, the House is expected to pass the budget measure passed by the Senate Thursday.
What are some of the replacement plans?
That is something that is not known yet. According to Politico, there is a Jan. 27 deadline for a draft of the legislation that would replace the ACA. Some senators want to push the deadline to March 3.
House Majority Leader Kevin McCarthy, R-Calif., said Wednesday that Republicans hope to get a plan on the new legislation to President-elect Donald Trump by the end of February.
Some Republicans want to see what is being proposed before they consider repealing the ACA. No replacement legislation has been made public.