Senate Health Care Vote: Where the Debate Left Off and What to Watch

But because the latest version of that measure has not yet been assessed by the nonpartisan Congressional Budget Office, it needed 60 votes for passage. Republicans have only 52 seats, so its failure was inevitable.

In the end, the measure won only 43 votes, demonstrating that even after weeks of refining the legislation, Senate leaders still fell far short of enough support for their replacement plan, from both ends of the party’s ideological spectrum. The Senate adjourned around 10 p.m. Tuesday.

What’s happened so far on Wednesday?

Mr. Trump opened the day by attacking Ms. Murkowski.

But Mr. Trump’s public shaming is not an effective strategy for Ms. Murkowski who has dealt with worse from her party. In 2010, Ms. Murkowski retained her Senate seat in a historic win as a write-in candidate. She had lost Alaska’s Republican primary that year to a Tea Party challenger and was largely abandoned by Republican leadership. Since then, she has not felt beholden to her party.

Now what happens in the Senate?

Senators are set to consider a different repeal measure on Wednesday.

This measure would repeal the health law but would not provide a replacement for it. The legislation resembles a bill that passed the Senate in 2015 but was vetoed by President Barack Obama in early 2016.

Senator Rand Paul, Republican of Kentucky, supports that approach. But some Republicans worry that repealing the law without providing a replacement would leave many Americans without health care coverage. Such a “repeal only” measure is not expected to garner enough votes for passage.

The vote for this measure is scheduled for late Wednesday morning.

Then what happens?

Republicans are using special budget rules to try to pass a repeal bill, so the debate is limited to 20 hours, and Democrats cannot delay it with a filibuster. Later this week, the Senate will hold what is known as a vote-a-rama, an exhausting marathon of amendment votes.

The nine Republicans who voted against the comprehensive replacement measure on Tuesday night are an indication of the problem that Senate Republican leaders continue to confront: The party caucus still does not agree on what should be in a health care repeal bill that would have enough support to win Senate approval.

One solution might be to pass a pared-down health plan that has support from at least 50 of the 52 Republican senators, and then turn to working out a compromise with the House.

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