After seven months of strategizing, debate and closed-door meetings, the Senate finally is voting. Senate Republican leaders can only afford to lose two Republicans. One is almost certainly gone, Senator Susan Collins of Maine. Senators Dean Heller of Nevada, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska are still on the fence, but leaders think they can win them over. Senator Rand Paul of Kentucky, one of the most vocal opponents of the Republican bill to replace the health care law, now appears ready to at least debate it.
If the motion to begin debate passes, the first vote will be on legislation to repeal the Affordable Care Act without a replacement. That is likely to fail, and would be followed by a vote on the Senate Republican bill to replace the health law.
If that also fails, Senate leaders may fall back on a narrow bill that repeals the Affordable Care Act’s mandate that nearly everyone have health insurance, a separate mandate that most employers offer their employees health insurance and a repeal of the medical device tax.
The goal of that would be to simply get senators to negotiations with the House on a final repeal measure.
As vote looms, Trump turns up the heat.
The Senate moved toward a showdown vote Tuesday afternoon on whether to begin debate on legislation to repeal the Affordable Care Act — and President Trump kept up a drumbeat on Twitter to force a “yes.”
That crafted missive came after a stream of other tweets designed to cajole, pressure and badger Senate Republicans 50 of whom he needs just to start the debate on his promise to repeal President Barack Obama’s signature domestic achievement.
And a man who has never apologized for questioning Senator McCain’s heroism in Vietnam was suddenly very appreciative of his decision to fly in from Arizona after his brain cancer diagnosis to cast his vote.
Obamacare is dead? Not so fast.
Centene, one of the largest health insurers offering coverage under the Affordable Care Act, continues to defy the Republican talking point that the individual market is collapsing. One of the rare insurers that increased its bet on the marketplaces as many of its competitors exited, the company reported higher quarterly profits on Tuesday.
“The marketplace business continues to be particularly strong, confirming our business-as-usual approach,” said Centene’s chief executive, Michael F. Neidorff, in a statement. The company said it expected the business to remain strong for the rest of 2017.
The company reported significantly higher net earnings of $254 million for the three months ended June 30, compared to $170 million for the same quarter of 2016. Revenue climbed from $12 billion for the three months from $11 billion.
The insurer, which has traditionally served low-income individuals who are eligible for Medicaid, covers 1.1 million people in the marketplaces. Centene, based in St. Louis, has also benefited from the Medicaid expansion, adding an additional 1.1 million members.
In a call with investors, Mr. Neidorff acknowledged “the headline noise” surrounding the various Republican proposals to replace the Affordable Care Act. He said the company was working closely with state and federal officials to try to stabilize the individual market. “It is a moving target with a long way to play out,” he said.
Mr. Neidorff also emphasized the importance of government funding for subsidies to low-income people, saying the failure to provide them will only hurt the people who need them. President Trump has repeatedly threatened to end those subsidies. “The leaders in Washington bear a responsibility to ensure that doesn’t happen,” he said.
What is being voted on?
For years, Republicans have promised to repeal and replace the Affordable Care Act, which was President Barack Obama’s signature domestic achievement. But they have struggled to find a consensus on how, exactly, to go about dismantling the law and installing a replacement.
The Senate majority leader, Mitch McConnell of Kentucky, says it is time for a vote.
On Tuesday, he will have the Senate vote on a motion to proceed — in this case, on whether to take up a health care repeal bill that narrowly passed the House in May.
Nobody expects that bill to become law. Instead, it would essentially serve as the vehicle for the Senate’s legislation. The House bill’s text would be swapped out for the Senate’s preferred language, whatever that ultimately is.
How does the voting math break down?
Republicans hold 52 seats in the Senate, and to be successful, they need a majority for the motion to proceed. In a deadlock, Vice President Mike Pence would break the tie in favor of proceeding.
Only days after announcing he has brain cancer, Senator John McCain, Republican of Arizona, plans to return to the Senate on Tuesday. His presence means Mr. McConnell can afford for two Republicans to vote against the motion. If Mr. McCain had been absent, Mr. McConnell would have been able to lose only a single Republican.
At least one defection is all but certain: Senator Susan Collins of Maine indicated on Monday that she would vote against proceeding in just about every imaginable circumstance.
Which senators are pivotal votes?
One big factor is what Mr. McConnell plans to do after the procedural vote.
For example, Senator Rand Paul of Kentucky is an expected “no” vote if after clearing the procedural hurdle, the Senate turns to a bill by Mr. McConnell to repeal and replace the health law. Mr. Paul detests that bill.
On the other hand, Senators Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska indicated last week that they would not vote to proceed if Mr. McConnell afterward scheduled a vote on a bill to repeal the health law without providing a replacement.
In addition, a number of other Republican senators have expressed varying qualms, with varying degrees of certitude. They include Mike Lee of Utah, Jerry Moran of Kansas, Rob Portman of Ohio and Dean Heller of Nevada.
What happens if the vote succeeds?
Such a vote would start the debate in the Senate on health care. At some point, Mr. McConnell is expected to offer an amendment that would substitute a new measure for the text of the bill that passed the House. But it remains to be seen what that new measure would be. Republicans are trying to pass the bill using special budget rules that limit debate to 20 hours and prevent a Democratic filibuster.
What happens if the vote fails?
Republicans are not expected to abandon their repeal effort, but its future would appear bleak, at least in the short term.
“We’ll go back to the drawing board,” Senator John Thune of South Dakota, a member of the Republican leadership, said on “Fox News Sunday.” Of voting to repeal and replace the health law, he said, “It’s not a question of if, it’s a question of when.”
Recent history provides some support for Mr. Thune’s optimism. The repeal bill in the House was declared dead before coming back to life — and Republicans there ultimately succeeded in passing a bill.