On Tuesday, the Senate very narrowly voted to open debate on a bill to at least repeal much of the Affordable Care Act, and Tuesday night, nine Republicans and 48 Democrats and independents shot down Senate Majority Leader Mitch McConnell's plan to repeal and replace ObamaCare. (McConnell's modified Better Care Reconciliation Act "is not necessarily dead," Axios notes. "Another, simpler version — like the most recent one scored by the Congressional Budget Office — could still come up later in the process.")
Late Wednesday morning or early afternoon, the Senate is expected to vote on a measure to repeal ObamaCare without a replacement plan, similar to a bill Republicans passed in 2015, thwarted by former President Barack Obama's veto. It is widely expected to fail, too. If so, the last plausible option for Senate Republicans is to pass what's being called "skinny repeal," scrapping ObamaCare's personal and employee mandates and a medical device tax, but leaving Medicaid, ObamaCare subsidies, benefit regulations, and everything else in place. "Basically no senators will like it," Politico explains, "but they may vote for it just to keep the repeal drive going."
Assuming the House wouldn't hold an up-or-down vote on the "skinny repeal" bill, it would go to a House-Senate conference committee, where Republicans would try to come up with a bill that could pass in both chambers. "The endgame is to be able to move something at the end of this process across the Senate floor that can get 50 votes and then to get into conference with the House," said Sen. John Thune (R-S.D.).
Before a final vote, the Senate will consider dozens of amendments, in what's being called "vote-a-rama" sessions, likely starting Thursday night. The Senate parliamentarian will also likely be asked to approve or throw out measures that don't meet the restrictions of the budget reconciliation process Republicans are using. Nobody knows where this unusual legislative effort to modify a huge chunk of the economy and a health-care system used by tens of millions of Americans will end, but it is expected to conclude early Friday. "All we have to do today is to have the courage to begin the debate with an open amendment process," McConnell told his caucus on Tuesday. "And let the voting take us where it will."