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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

1 hour ago - World

Biden backs Gaza ceasefire for first time in call with Netanyahu

Biden with Netanyahu in 2010. Photo: Debbi Hill/Pool/ Getty Images

President Biden expressed support for a ceasefire between Israel and Hamas in a call on Thursday evening with Israeli Prime Minister Benjamin Netanyahu, the White House said in a statement.

Why it matters: This is the first time since the beginning of the crisis last Monday that Biden or anyone in his administration has publicly backed a ceasefire. It will increase pressure on Israel to seek an end to the conflict, which Netanyahu has insisted will continue until Hamas' ability to attack Israel is further degraded.

3 hours ago - World

Schumer: "I want to see a ceasefire"

Photo: Sarah Silbiger/Bloomberg via Getty Images

Senate Majority Leader Chuck Schumer (D-N.Y.) told reporters Monday he wants to "see a ceasefire reach quickly and mourn the loss of life."

Why it matters: Schumer is a staunch defender of Israel and has maintained that Israel should be able to defend itself.

6 hours ago - Health

Biden administration to send 20 million U.S.-authorized vaccine doses abroad

Photo: Ole Spata/Picture Alliance via Getty Images

President Biden will send an additional 20 million doses of coronavirus vaccines to other countries by the end of June, including shots authorized by the FDA for use in the U.S., White House press secretary Jen Psaki said Monday.

Why it matters: It will be the first time the U.S. has sent Pfizer, Moderna, and Johnson & Johnson vaccine doses abroad. The administration previously announced plans to export 60 million doses of the AstraZeneca vaccine, which has not been authorized domestically.