Republicans’ last-ditch plan to save their health bill, explained in 500 words

The two leading versions of the Senate Republican health bill have now both gone down to defeat on the Senate floor this week — Mitch McConnell’s bill failed Tuesday night, and a “repeal-and-delay” bill preferred by conservatives failed Wednesday afternoon.

But Republican leaders now have one last-ditch plan to keep their effort to repeal Obamacare alive.

Senate leaders’ new plan is to try to pass a simple, stripped-down “skinny repeal” bill that gets rid of just a few Obamacare provisions — like the individual and employer mandates and the medical device tax — while leaving the bulk of the law in place.

We don’t yet know whether skinny repeal will pass the Senate, or whether enough Senate Republicans will unify around some alternative proposal that can squeak through. We don’t even yet know what, exactly, would be in a skinny repeal bill.

But if the leadership’s reported plan succeeds and Republicans do end up passing skinny repeal out of the Senate, there are two main possibilities for what would happen next: Either House and Senate Republicans will hammer out final text that goes back before both chambers or the House will just pass the Senate’s bill.

1) Republicans narrow down one final version of the bill, which goes back for another vote in both the House and Senate: GOP leaders in the Senate are currently selling their plan to pass skinny repeal not as an intended final product, but as a vehicle to kick-start some sort of conference committee process.

This is the process where, after the House and Senate pass different versions of the same bill, negotiators from both chambers come together to try to agree on its final text. (This could involve the formal creation of a conference committee, or more informal negotiations between leaders in each chamber.)

We don’t know how this process would play out. Party leadership could well push hard for a sweeping repeal-and-replace and Medicaid restructuring bill that looks like Paul Ryan’s House-passed bill, or the bill Mitch McConnell tried and failed to get through the Senate. It’s also possible that something more limited could be crafted, if party leaders think that’s their best chance to get something passed.

But in the end, just one bill would emerge, and it would need both House and Senate approval again. Republicans in both chambers would then be put under tremendous pressure to vote for it.

2) Skinny repeal gets jammed through the House — and Trump signs it: Alternatively, GOP leaders could calculate that the conference committee process is unlikely to succeed, and that no fuller repeal can get through the Senate.

If so, they could then try to jam the scaled-back skinny repeal plan the Senate had already passed through the House, as their last best chance to claim some sort of a “win” on the issue.

House conservatives may grouse, but if they’re convinced the Senate’s plan is the best they’ll ever get, they could come around and vote to send skinny repeal without any changes to Trump’s desk for his signature.

Those appear to be the two paths forward for the GOP health bill at this point.