The 7 steps ahead for Senate Republicans to pass their health care bill

Senate Majority Leader Mitch McConnell, flanked by Sen. Cory Gardner (R-CO), Sen. John Barrasso (R-WY), and Sen. John Thune (R-SD), speaks to the media after the weekly policy luncheon on Capitol Hill May 2, 2017 in Washington, DC.
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Senate Majority Leader Mitch McConnell, flanked by Sen. Cory Gardner (R-CO), Sen. John Barrasso (R-WY), and Sen. John Thune (R-SD), speaks to the media after the weekly policy luncheon on Capitol Hill May 2, 2017 in Washington, DC.

Senate Republican leaders are shifting gears in their health care crusade, dropping their existing bill and instead trying to force a vote on a bill from 2015 that would repeal large swathes of Obamacare without any plan to replace it.

But the path to voting on that bill is an obstacle course. It could fail at multiple points — on the initial procedural vote or on final passage. An unpredictable amendment process could send the bill in unexpected directions. Clean (partial) repeal sounds simple, but the Senate procedure makes it anything but.

Passing the 2015 bill faces the same math problem that the now-dead Better Care Reconciliation Act did: Senate Majority Leader Mitch McConnell needs 50 of the 52 Senate Republicans to back the plan under the special procedural rules Republicans are using to pass the bill with a bare majority.

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Congressional Republicans already passed the partial repeal bill in 2015, but President Barack Obama vetoed it. It would cut funding for all of Obamacare — spending on subsidies for private insurance and the Medicaid expansion — and repeal taxes on the wealthy and health care industry, as wall as the law's individual mandate.

It would not, however, repeal the law's insurance regulations — those are considered untouchable under the Senate's procedural rules. None of the repeal would take effect for two years.

Sen. Susan Collins (R-ME) opposed the 2015 bill, and Sen. John McCain (R-AZ) is recovering from a health scare in Arizona. That leaves McConnell with no room for error, and the moderate members who were already skittish about BCRA might balk at a plan that is estimated to lead to even fewer Americans have health insurance than the initial Senate bill.

The starting point for Senate debate is the House health care bill passed in May. Eventually, Senate Republicans will swap the House bill for the partial repeal bill — if they get that far.

The path forward is complex. Here's what could happen next.

1) McConnell will make a motion to start debate on the House bill. That step — known as the motion to proceed — will require 51 votes. Collins and McCain mean Republican leaders are already down two votes. More moderate senators are refusing to commit to voting to start debate. Vice President Mike Pence could break a 50-50 tie.

2) The Senate would debate the House legislation on the floor for 20 hours, with that time divided evenly between Republicans and Democrats. That's 20 hours of debate time, not real time, so the debate could last a couple of days.

3) At the end of the debate, there would be a "vote-a-rama," during which senators can offer an unlimited number of amendments to the bill. Amendments that are considered "germane" to the health care legislation need 51 votes to be added to the bill.

4) At some point, either during debate or after the vote-a-rama, McConnell would offer the 2015 Senate repeal bill as a substitute for the House bill. The timing would depend on whether McConnell wants the amendments brought up during vote-a-rama to be added to the final bill or not. This will be a key decision: If McConnell waits until the end to introduce his substitute, then none of the amendments that were added during vote-a-rama will actually be part of the final legislation.

McConnell has said that the 2015 bill would be the first amendment offered during the debate, which means any following amendments that are approved would be added to the final bill. Conservatives could try to tug the bill further to the right. Democrats could try to lure a handful of moderate Republicans with provisions that they favor and add them to the bill. It would be an unpredictable process.

5) The Senate would take a final vote on passage of the Senate repeal bill. That would require 51 votes, another dicey proposition given the estimated 32 million fewer Americans would have health insurance under the partial repeal bill. Pence could break a 50-50 tie.

6) If the Senate passes the bill, the House would probably take it up and pass it as is. The other option would be for the two chambers to negotiate a new plan, but most people in Washington expect the House to simply approve the Senate bill. A bare majority, 218 members, must vote for the bill for it to pass.

7) Once both chambers pass the Obamacare repeal bill, President Trump would sign it into law.