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The Senate's health care circus is just getting started

Lazaro Gamio / Axios

We still don't know — no one knows — how the Senate's health care process is likely to end. But it's now well under way. And as the lopsided defeat of the Senate repeal-and-replace plan last night showed, there could be plenty of surprises ahead.

Here's where things stand as we barrel toward some kind of conclusion tomorrow night.

  • The Senate last night voted down a modified version of Republicans' larger repeal-and-replace bill, the Better Care Reconciliation Act. But BCRA is not necessarily dead. Last night's version included provisions that haven't been scored or reviewed by the parliamentarian.
  • Another, simpler version — like the most recent one scored by the Congressional Budget Office — could still come up later in the process, a senior GOP aide told us.
  • Technically, last night's vote was procedural, but it's extremely reasonable to take that vote as a proxy for the policy itself.
  • The next vote, scheduled for early this afternoon, will be on the updated version of the 2015 repeal-only bill. That, too, is expected to fail.
  • All signs point to a vote-a-rama Thursday night, perhaps into Friday morning.

The hot new thing: "Skinny repeal." If neither BCRA nor straight repeal looks to be gaining any traction, the next option in the rotation appears to be a bill that would repeal small parts of the ACA — like the individual mandate and a tax or two.

  • The goal here wouldn't necessarily be to settle for that outcome, but to pass something that would trigger a conference committee with the House. Normally designed as a way to hammer out specific differences in House and Senate bills, a conference here would function more like another opportunity to write another bill — albeit under many of the same restrictions.
  • House Republicans aren't sure yet how they feel about this option. They're waiting to see what — if anything — the Senate actually sends them. But anything that keeps the process alive would be a good thing, a senior House GOP aide told Axios' Caitlin Owens.