Here's how health care got back on the front burner in Washington

We thought the debate was over for this year, but now it's back. Here's why.

If it seems like Congress has been debating health care bills pretty much all year, that's because they have been. 

Republicans have been trying to agree on a plan to repeal the Affordable Care Act and replace it with something else. 

A House plan failed in March. But a different version came back in May and got passed. The Senate didn't like the House plan but its "skinnier" alternative was also rejected in July, which seemed to end the health care debate for the year.

But no. It's back with a new version called the Graham-Cassidy bill. The Senate majority leader's spokeswoman tells Politico the plan is to bring it up for a vote next week. But only if it has enough support to pass. 

It's not clear yet if the bill does have the needed votes, but President Donald Trump was lobbying for it on Twitter Wednesday. 

How did health care get revived?

First a little explanation.

Unlike the House, the Senate has no limits on the time spent debating. So opponents of a bill can block it by talking non-stop, which is known as a filibuster. The Constitution allows this but says the filibuster has to stop if three-fifths of the senators (60 of them) vote to end debate.

At least that's how it normally works. 

In 1974 Congress created an exception that says the regular rules can be suspended to allow for speedy consideration of budget proposals –specifically taxes, spending, and the debt limit. This fast track is known as "budget reconciliation" (learn more about it here) and when it's used, no filibusters are allowed.

This year Republicans – who have a 52-48 majority in the Senate – activated this exception for the health care debate. Since filibusters aren't allowed there's no need for 60 votes, 51 is enough to pass the bill. 

The suspension of the regular rules is temporary, though, and in this case it ends on Sept. 30. 

So there are 10 days left for Republicans to pass a new health care law with only 51 votes – meaning without needing any Democratic votes. 

That's why this Graham-Cassidy bill is considered a last ditch effort. 

Vox explains its resurgence this way: "After being dismissed as a joke for most of the past two months, Cassidy-Graham has forced Washington to take it seriously, no doubt aided by the September 30 deadline and the expiring dream of Obamacare repeal."

What would Graham-Cassidy do?

You can read a summary of the bill here but the key points are:

  • No mandates. People wouldn't have to carry health insurance and businesses would not have to offer it to workers.
  • Federal money for health insurance would become block grants that would be given to the states to use however they want.
  • The expansion of Medicare that happened under Obamacare would be reversed. 

Critics have complained that Graham-Cassidy would let insurance companies deny coverage to people with existing health conditions and would allow much higher premiums for older Americans, the Cedar Rapids Gazette notes

Also, the Congressional Budget Office will not be able to analyze the effects of Graham-Cassidy by September 30, Politico says. That means the bill's effect on insurance costs and the number of uninsured will be a question mark if a vote happens before then. 

Will it pass?

Nobody knows yet. 

Three Republicans voting no would be enough to sink it. Sen. Rand Paul of Kentucky is one Republican who has said he'll vote against it. 

Three other Republicans who are leaning against the bill – John McCain, Lisa Murkowski, and Susan Collins – are being lobbied hard by supporters this week, Fox News says.

Because after Sept. 30 the health care debate goes away. 

Doesn't it?

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