CODE RED: How to Resist Trumpcare Now that Republicans Passed the Motion to Proceed

If you’re reading this, you’re likely immeasurably stressed. Take a moment to breathe and concentrate. Do not give up. Do not give in. Channel your anger into your activism. We all need to be energized, on our game, and laser-focused to defeat Republicans’ efforts to decimate our healthcare, especially over the next few days, and ESPECIALLY over the next 24 hours (real time, not Senate time). We’re looking at debate today and tomorrow, a possible vote-a-rama on Thursday, and a final Senate vote as soon as Thursday night or Friday.

Republicans barely managed to pass the motion to proceed with Mike Pence as tiebreaker, which opened debate on an unknown number of potential Trumpcare bills (Republicans just released an extraordinarily rough outline of an outline of one of them the same day as the motion to proceed vote) as well as full repeal of the ACA and the Medicaid expansion. The motion to proceed was a procedural vote to start debating how they want to destroy our healthcare system — but we’re only at step one. To be absolutely clear, it did not repeal the ACA or pass Trumpcare. It began the process that could culminate in one of those outcomes, but we still have time to resist like never before. And it’s our moral responsibility to do so.

Here’s what happens next. Remember, the reason that Republicans needed the motion to proceed in the first place is because they want to ram through Trumpcare (we’ll term it as such for the sake of clarity, but understand that “Trumpcare” is here short for any of the myriad repeal or repeal-and-replace bills that Senate Republicans have up their sleeves to destroy our healthcare) via reconciliation, meaning they only require a simple majority of only 51 votes to pass it. The motion to proceed starts 20 Senate hours of debate — Senate hours because the Senate will not debate for 20 hours straight, but will divide them up over two days. The Senate cannot debate for more than 20 hours and the House and Senate can take no more than 10 hours to come to a compromise. The Washington Post and Center on Budget and Policy Priorities published trackers to follow what Republicans plan to vote on, when, policy details, and senators to watch so you can stay up-t0-the-moment.

However — and this is vital — reconciliation allows senators to offer as many amendments as they want. The catch is that they must be relevant to the bill (which is logical) and that they receive minimal debate. Once the 20 hours of debate elapses we enter what’s called the vote-a-rama. Yes, admittedly the name “vote-a-rama” is an awful attempt to make a legislative procedure sound fun and hip, but it’s in truth invaluable for our purposes. Reconciliation legislation can’t be filibustered, one of the primary reasons that Republicans want to utilize it for Trumpcare, but Democrats can filibuster by amendment. They can submit thousands of amendments to slow down the process and delay the final vote. The catch is that they don’t get a break, so once they tire out, they’re done. While McConnell could cut them off, Democrats are entitled to bring up as many amendments as they choose so long as they meet the above prerequisites. And if you haven’t already submitted your amendment to your senators to help them prolong this process as long as humanly possible, you can and should do so right now.

Democrats, however, have decided to call Republicans’ bluff. McConnell is eager to vote on a bill the same or the following day that Republicans are writing it over lunch. In the face of McConnell’s utter contempt for Senate rules and procedures, Democrats are demanding to see bill text before moving forward with the vote-a-rama. They have hundred of amendments ready, but refuse to permit McConnell to hold them and the American people hostage if they have any leverage they can use to prevent it.

Reconciliation also comes with another set of strictures. It must directly lower the federal budget, hence last week’s kerfuffle over the parliamentarian’s determination that elements of Trumpcare (now we’re specifically discussing BCRA, or the oh-so-ironically dubbed Better Care Reconciliation Act) fail to do so. The parliamentarian subjected the bill to the Byrd rule, which tests out whether or not its individual elements are germane to reducing the deficit. Essentially, any provision that regulates the insurance market, like forbidding patients on Medicaid from seeking care at Planned Parenthood (although Republicans are already retooling language to make this fly in the bill), and locking people who lose insurance for just over 2 months out of the insurance market for 6 entire months, are no-gos. Others that fail to meet the standards of the Byrd rule include kickbacks such as the Buffalo Bribe in the House Trumpcare bill, the likes of which McConnell has been using to coerce reluctant Republicans into voting for the it, as well as allowing states to allocate block-grant Medicaid money to pretty much whatever purpose they want. Trumpcare emerged rather bedraggled from its Byrd bath, to put it mildly. Now, McConnell could go nuclear and ignore the parliamentarian’s decision, which we shouldn’t assume is off the table because his record abundantly proves that his respect for Senate norms is minimal. But it would mean an irreparable break with democratic procedure and isn’t likely to obtain extensive consensus.

As of Tuesday night, the Senate Trumpcare bill (BCRA) failed to pass with nine Republicans joining Democrats. This does not mean that we’ve seen the last of the Senate Trumpcare bill that’s been the hot topic of the last few weeks, since parts of it still lack a CBO score and the parliamentarian’s deliberation. Next up, Republicans voted on straight repeal of the ACA and Medicaid expansion, the Obamacare Repeal Reconciliation Act (ORRA) Wednesday afternoon. It failed with Susan Collins, Dean Heller, Lisa Murkowski, Lamar Alexander, Shelley Moore Capito, John McCain, and Rob Portman joining all the Democrats to oppose it.

Although the Cruz amendment tanked on Tuesday, it’s still very much worth reviewing it, since it raises invaluable points that could return over the course of the debate.

Recall that the Cruz amendment still lacks and isn’t likely to get a CBO score, since Republicans are afraid that the ugly numbers resultant from it would crucify (or Cruz-ify, if you will) them. Rather than allowing the nonpartisan CBO to score the bill, McConnell had Tom Price’s (you remember him, the one who championed the 2015 ACA repeal bill that made it to President Obama’s desk for a veto) Health and Human Services department do so. Not only was their analysis predictably inaccurate and biased, it drew scorn and derision from healthcare experts. To recap briefly, the Cruz amendment bifurcates the insurance market. It allows states to offer cheap bare-bones coverage that’s useless provided they also offer a fully ACA-compliant plan. The problem is obvious. People with chronic illnesses and disabilities, and likely women, would need the ACA-compliant plan that covered essential health benefits, while everyone else would flock to the cheap but worthless plans. Compliant plans would already be inordinately expensive, and once you have the people with the highest healthcare needs purchasing them, you’ve created a high-risk pool through the back door. Costs for those plans will increase astronomically, pricing people with preexisting conditions out of the market and establishing the conditions for a death spiral. Meanwhile, the cheap plans won’t provide the care people need, so inevitably hospitals will wind up hemorrhaging money and taxpayers will foot the bill. Recollect as well that once a single state eliminates essential health benefits, that opens the door for any employer plan to stop covering essential health benefits as well, reinstating lifetime and annual caps.

The most plausible plan to pass is Republicans’ most recent endeavor that, if it passes, officially means that we’re living in a banana republic. This plan has no bill text and no CBO score. Republicans are writing it over lunch mere hours before they plan to vote on it. They’re already lining up votes without having a clue of what’s in it. Meet their awkwardly dubbed “skinny” repeal, which we’re going to follow Topher Spiro’s lead in renaming the Trojan Horse plan to provide a clearer image of the profound threat it poses. Calling it a “skinny” repeal makes it sound innocuous, but the truth is precisely the reverse. The idea behind it is to claim to limit Trumpcare to repealing core provisions of ACA: the individual mandate and the employer mandate, in addition to funding for public health purposes that states rely on. And since McConnell is no longer seeking to woo Collins and Murkowski, who have held firm in their commitment to protect Americans’ healthcare, he’s also including a provision forbidding Medicaid patients from seeking care at Planned Parenthood.

Repealing the individual mandate alone would upend the markets and unleash rampant harm on people’s lives. Without the individual mandate, the ACA falls apart, as it would lack a mechanism to ensure that everyone bought insurance, and thus that there’s enough money pooled together for everyone to afford insurance. Democrats asked the CBO to score this Trojan Horse plan as it currently stands, revealing that 16 million people would lose healthcare if Republicans repeal the individual mandate. Once again, it’s a classic recipe for a death spiral, and would exacerbate all of the elements of the ACA Republicans have railed against for years. People will be forced to pay a whopping 20% more for their healthcare, since prices will skyrocket. It would also result in a drop in Medicaid enrollment. Republicans appear to be coalescing around this plan and reports suggest that leadership may add paltry funding for opioid treatment to get the rank and file on board. States have tried this before and it invariably ended poorly: insurers fled, people lost healthcare, prices rose exorbitantly, and local economies suffered.

But as bad as that is, that may not be the worst of it. Republicans are pushing the Trojan Horse repeal option as a possible point of agreement that they could vote out of the Senate, so they could then go to conference with the House and hash out their differences. In practice, that means Republican leadership and a specifically selected team would secretly draft a bill based on the House Trumpcare bill with no hearings, no expert or patient testimonies, no Democratic input, no bill text for the public to see, and no debate, and then drop it suddenly on their members for a September vote. At that vote, representatives cannot offer amendments and get only ten minutes of debate, strengthening McConnell’s prospect of ramming this secretly constructed bill through. Which in turn means that Republicans will face even more intensive pressure to vote for the bill than they do now, since they’d be limited to two choices: a yes or a no. And you can bet that conservative groups will do whatever they can to impel Republicans to support whatever the repeal legislation turns out to be, lest (gasp) they brand themselves as actually caring about their constituents by entering on a bipartisan effort to improve the ACA.

Republicans’ major concern right now is making it to 50 votes so that Pence can push them over the edge to pass a bill to destroy our healthcare and wreak havoc on our economy. The House could pass it as is or enter conference with Senate leadership and a hand-picked crew (which we can safely assume will include no women). And that’s what the Trojan Horse repeal could turn out to be: a procedural trick to get to conference where Republicans would bring back the House Trumpcare bill (AHCA), causing over 20 million people to lose healthcare, gutting central ACA protections, and slashing Medicaid.

Expect that McConnell will introduce whatever the final bill is at the last minute via an amendment. This could wipe out all of the amendments the Senate passed over debate. Or it might not. We don’t really know. What we do know is that it’s classic bait-and-switch, and it will be the Trojan Horse “skinny” repeal bill that, allow me to reiterate, still lacks bill text and only got a CBO score because Democrats brought the bullet points to the Congressional Budget Office.

And then Thursday afternoon and evening happened and all hell broke loose. Lindsey Graham, John McCain, and Ron Johnson held a press conference to announce that they would only support the Senate Trojan Horse bill — of which we have seen no text — if the House promises that it will not become law as written. Let that sink in. Three Senate Republicans declared that they would refuse to support their own bill UNLESS they know for a fact that it will not become law. Ryan will make no such promise, indicating that he reserves the right to pass it in the form in which the House receives it, or to enter conference with the Senate. Given that House Republicans invoked legislative martial law in order to evade intervening time between the Senate’s passage of the bill and their own vote, Graham, McCain, and Johnson shouldn’t count on any promise from the House Speaker. Why martial law? That way, their constituents, their members, and the media have no time to familiarize themselves with the bill and are forced to take an up or down party-line vote. To term this a shameful disgrace is far too generous.

Those are the most important policy points for right now. Time to dive back into process. Republicans voted for the motion to proceed without knowing what it is they’re voting on. Not only is this the total abdication of responsibility, it’s a point of weakness. We need to remind them of this every. single. day. We need to remind them that no matter which plan they choose, millions of people will lose healthcare. We need to remind them that decimating our healthcare will upend one sixth of the economy, establishing the conditions for another recession and mass unemployment.

We need to unleash a flood of calls like never before. Calendar reminders into your phone or paper planner to call your senators daily — yes, whether your senators are Democrats or Republicans. No one who cares about our healthcare, our economy, or our democracy gets to sit on the sidelines. Indivisible Guide put together scripts with asks for both Democratic and Republican senators. Key for Democrats is to urge them to filibuster by amendment, and stress that any component of the bill that breaks the Byrd Rule is unacceptable. Key for Republicans is to urge them to vote no on any bill that would result in anyone losing healthcare, and uphold the rulings of the parliamentarian. Emphasize calling your own senators, but we also need moderate Republicans on board. If both of your senators are Democrats, you can also phonebank from home to encourage people in red states to call their representatives! And don’t forget to call your House representatives, since if Senate Republicans succeed in passing a bill, it’ll go to conference where House and Senate representatives hash out their differences and hammer out the details. You can also fax your senators by texting “resist” to 50409 or visiting resistbot on facebook. If your fax is longer than 200–250 words, I suggest using Facebook, since the texting version limits the length of your fax.

Just three Republicans voting no will defeat Trumpcare. Reinforce our gratitude to Susan Collins of Maine and Lisa Murkowski of Alaska by calling to thank them for their no votes on the motion to proceed, and ask them to keep putting people before party and also vote no on the resultant bill. Shelley Moore Capito of West Virginia is also a key senator to call. She came out against full repeal last week but voted for the motion to repeal today — with the caveat that she might not vote for the final outcome. Be respectful but firm. Tell your story. Hold your senators and Republicans personally accountable for every person whom any version of Trumpcare, including full repeal, will harm.

We face a crisis of historic proportions, one that will emblematize our own and our country’s character. We cannot sit or stand idly by and permit millions of people to lose their healthcare without a fight. Warm up those dialing, faxing, and tweeting fingers, and rise up as one voice to defend our healthcare!