Lazaro Gamio / Axios

We're hours away from a series of votes that will culminate, we think, with a brand-new bill to repeal part of the Affordable Care Act. Of course, no one's seen it. Senate Republicans don't know where they're headed, but they're putting the pedal to the metal to get there.

The Senate's health-care process (such as it is) is somehow both a flat circle in which everything we have done, we will do over and over and over again forever; and a rushing river that's never the same from one second to the next, in which it's barely possible to keep your head above water.

Here's where things stand this morning:

  • Majority Leader Mitch McConnell is still working on the latest ACA repeal bill, after two other versions have already failed. Like its predecessor, this one — "skinny repeal' — is also being written in secret with little to no outside input.
  • Even key Republicans don't know what's in the bill: "There is no definition to any of it right now," Sen. Lisa Murkowski said yesterday.
  • While they try to figure out something they can pass with 50 votes, Republicans will burn a little time today trolling Democrats about single-payer.
  • Democrats, for their part, have said they won't offer any amendments until they see the "skinny repeal" bill.
  • This could all be over — somehow or another — in about 24 hours. Not because Republicans agree on any one policy, or even on the broadest set of principles about what's good or bad in the health care system, but because they'll run out of time.

It's going great.

The last resort: If the Senate's going to pass anything, it looks increasingly like that would have to be "skinny repeal" — which, in addition to being a terrible name, is also not yet a finished bill and has not been officially scored by the Congressional Budget Office. But we know it would probably repeal the Affordable Care Act's individual and employer mandates, along with the medical-device tax, and maybe some additional taxes.

The appeal: "Skinny repeal" only touches the most unpopular parts of the ACA — and unlike the rest of the Senate's proposals, it comes with a built-in insurance policy against total failure.

Conservatives still want to repeal more than just these two mandates. But passing something and getting into a conference committee with the House looks increasingly like the only way to keep that dream alive.Even if that process falters, who wants to be the Republican standing in the way of repealing the individual mandate? McConnell's argument about a binary choice — pass this or live with the ACA — gets stronger the closer he gets to his last resort. And he's getting pretty close. Skinny repeal wouldn't directly cut Medicaid, which will help reassure Sens. Dean Heller and Shelley Moore Capito (though if it goes the conference-committee route, conservatives would likely take another stab at Medicaid cuts).The catch: Repealing the individual mandate would probably cause premiums to spike and some markets to deteriorate. Industry doesn't like it, either. Insurers have always said the individual mandate needs to be retained or replaced, and the American Medical Association came out against the idea yesterday.Where it stands:Sen. Ted Cruz said he wants lawmakers to be "focusing like a laser on lowering premiums" — which skinny repeal would not achieve. But he hasn't ruled it out.But House Freedom Caucus Chairman Mark Meadows is against it.Several other senators said they couldn't comment because they didn't know what was in the bill. Which is true, but that didn't stop the motion to proceed to this debate. And "skinny repeal" is in some ways comparable to a new motion to proceed — to another unknown and secretive process, but with a little bit of repeal as a backstop.

Go deeper

Updated 2 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 2 a.m. ET: 19,638,142 — Total deaths: 726,786 — Total recoveries — 11,939,423Map.
  2. U.S.: Total confirmed cases as of 2 a.m. ET: 4,998,017 — Total deaths: 162,425 — Total recoveries: 1,643,118 — Total tests: 61,080,587Map.
  3. Politics: Trump signs 4 executive actions on coronavirus aid — Democrats, and some Republicans, criticize the move
  4. Public health: Fauci says chances are "not great" that COVID-19 vaccine will be 98% effective — 1 in 3 Americans would decline COVID-19 vaccine.
  5. Science: Indoor air is the next coronavirus frontline.
  6. Schools: How back-to-school is playing out in the South as coronavirus rages on — Princeton, Johns Hopkins, Howard to hold fall classes online.
Updated 1 hour ago - Politics & Policy

Ohio Gov. Mike DeWine again tests negative for coronavirus after positive result

Photo: Justin Merriman/Getty Images

Ohio Gov. Mike DeWine (R) tested negative for COVID-19 for a second time after initially testing positive last week, he announced Saturday.

Why it matters: 73-year-old DeWine was set to meet President Trump Thursday on the tarmac at an airport in Cleveland and was tested as part of standard protocol.

Updated 2 hours ago - Politics & Policy

Republicans and Democrats react to Trump's coronavirus aid action

President Trump speaks to workers at a manufacturing facility in Clyde, Ohio, on Thursday. Photo: Scott Olson/Getty Images

Some Republicans joined Democrats in criticizing President Trump Saturday night for taking executive action on coronavirus aid, with Democratic leaders demanding the GOP return to negotiations after stimulus package talks broke down a day earlier.

Why it matters: Trump could face legal challenges on his ability to act without congressional approval, where the power lies on federal spending. Sen. Ben Sasse (R-Neb.) was the most vocal Republican critic, saying in a statement: "The pen-and-phone theory of executive lawmaking is unconstitutional slop."