The Senate Just Voted to Start Debating Health Care. Here’s What Happens Next

On Tuesday afternoon, Senate Republicans voted on a motion to proceed with debate on health care legislation, using a rare legislative gambit to move ahead despite reservations from some moderates. But unlike typical Senate procedure, many lawmakers are still unclear on what the actual bill will ultimately be.

With 52 Republicans in the Senate, Republicans could only afford two defections and that’s what they had. 50 Senators voted to support the measure. Only two Republican Senators, Lisa Murkowski and Susan Collins, voted no. All Democrats were unanimously opposed. With a 50-50 split, Vice President Mike Pence broke the tie.

The move appeared to have been designed to allow wavering moderate senators to vote to begin debate without seeming to support a version of the Obamacare replacement that they have criticized.

West Virginia Senator Shelley Moore Capito, for example, has repeatedly said she will not vote to repeal Obamacare without an adequate replacement, and has repeatedly expressed reservations about the impact the Senate’s version of the replacement bill would have on Medicaid recipients in her state. But Capito still voted to vote on a motion to proceed, noting in a statement that she would ” continue to make decisions that are in the best interest of West Virginians.”

After debate begins, it’s unclear what exactly will happen next, although some observers have speculated that Republicans will likely hold votes on a number of different health care proposals that will fail before moving to a minimalist version of repeal that can go back to the House.

Here’s what you need to know about the process and what happens next.

Step 1: Begin Debate

As expected, the Senate voted to proceed with a debate on health care legislation Tuesday afternoon, as shouts of “kill the bill, don’t kill us” filled the chamber. When Senators voted on the motion to proceed, they were not voting for a final piece of legislation; they are merely voting to start debate. If three Republicans had voted against the motion, the process would have ended here. Only two did.

Step 2: Debate for 20 Hours

The debate has now commenced. The motion to proceed was technically for debate on the House’s American Health Care Act, the version of the Obamacare replacement act they passed in May. Per Senate rules, the debate would last 20 hours, with equal time—10 hours—provided to both Republicans and Democrats. But there are restrictions within these 20 hours. According to Senate rules, any debate over an amendment can only last two hours, and a debate over an amendment to an amendment just one hour.

Immediately following the vote, McConnell offered an amendment to repeal Obamacare, in keeping with his promise to his fellow Kentucky Senator Rand Paul, who had been opposed to any version of a bill that did not fully do that. The amendment McConnell offered was the one that Congress passed in 2015, which provides a two year time frame repeal Obamacare and devise a replacement.

There are several other possibilities floating around as to what could be amended to the bill.

“There will be a lot of different amendments offered by different members trying to craft the bill,” McConnell said at a press conference after the vote, explaining he didn’t think it was possible to predict what concrete measures would ultimately be offered.

Votes can be held during the debate process, according to a Senate aide. But when asked if amendments would be voted on during the debate, an aide to Senator McConnell told TIME that updates would be provided after the Senate voted on a motion to proceed.

Step 3: Hold Lots of Votes

After the debate is over, the process would begin to actually vote on the ones that were proposed, although amendments can be added in at this point as well. This is what is known as a “Vote-a-rama.”

Different amendments would need a different number of votes to pass. Amendments that clearly fall within budgetary discretion and have been scored by the non-partisan Congressional Budget Office, like a repeal-only amendment, would need 52 votes. But an amendment can be challenged, particularly if the Senate parliamentarian deems amendments or portions of the bill fall outside the budgetary process. For instance, the Senate parliamentarian, Elizabeth MacDonough, ruled last Friday that several portions of the Senate bill, including the proposal to defund Planned Parenthood for a year and penalizing people who don’t buy insurance by making them wait six months before buying any, violated the Senate rules because they fell outside of the budget process. Although this ruling was only advisory, if Democrats officially challenge the proposals — which they probably will — those proposals could ultimately require 60 votes to pass if they stay in their current form, rather than 52, and are thus unlikely to succeed.

The Senate parliamentarian ruled on Tuesday that additional provisions in the version of the bill the Senate released on June 26 also violated Senate rules, and would require 60 votes. These include the proposal allowing insurance to increase taxes on elderly Americans, and the proposal to enable businesses to establish health care plans they could sell across state lines.

Step 4: Send a Finished Bill Back to the House

Once all the amendments have been decided and voted on, the Senate will vote on the bill’s final passage. Should 50 Senators still be on board, the Senate would pass the legislation and work out the differences with the House if they exist, likely in the form of a conference, before sending it to President Trump to sign into law. According to the Congressional Research Service, the chambers would create a conference committee, comprised of members from both the House and the Senate, to work out the differences, which would culminate in the signing of a report. Once that report is signed, it would need to be approved by both chambers before heading to Trump’s desk.

McConnell said he aims to have the Senate finished with the amendments by the end of the week, and either send it to the house or start a conference committee.

“This is just the beginning,” he said. “We are not out here to spike the football.”

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