THE INVISIBLE REBOOBLICAN HEALTH CARE BILL

Photo by Mark Wilson/Getty Images

VOX, SARAH CLIFF

Republican senators are set to vote on a bill to repeal the Affordable Care Act tomorrow. 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 tomorrow affecting all of that. And at this moment — 24 hours or so before they vote — they have no idea what the bill contains.

 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. 

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.

Is the point to wipe Obamacare off the books and go back to the old health insurance system? To come up with a new health system that costs less? Or covers more people? The goal has become finding something that can get 50 votes, with less attention paid to what that policy actually is.

"The debate over the Affordable Care Act is really a debate over wealth redistribution": "Overall, it would be ‘a big transfer. This is a massive tax cut for unpopular industries and wealthy individuals,’ said Andy Slavitt, who was acting administrator of the Centers for Medicare and Medicaid Services during the final years of the Obama administration. ‘It is about cutting care for lower-income people, seniors, people with disabilities and kids to pay for the tax cut.’” —Karen Tumulty, Washington Post