The beginning of the end for the Affordable Care Act started just before 1:30 a.m. on Thursday. In the final count, senators voted largely along party lines on a budget resolution that will set in motion the dismantling of President Obama's signature health care law.
You might have been sleeping while your senator cast their vote to preserve or destroy a system that extended healthcare to nearly 20 million people. There is currently no plan to replace it.
What happened early Thursday morning was dramatic, but it was also a bloodless procedural maneuver. The vote itself does not dismantle the health care law, but it does, if an identical resolution passes the House as it's expected to, compel congressional committees to come up with a proposal to repeal the pieces of the Affordable Care Act that have anything to do with the budget.
That means the individual mandate that keeps healthy people in the exchanges by leveling a tax against those who don't buy insurance, the Medicaid expansion, and insurance tax credits are all on the chopping block.
But the marathon session wasn't just about the budget. Democratic senators also introduced a flurry of amendments that, while not legally binding, were meant to signal the changes to come as Republicans move ahead with the repeal.
This is where partisan alliances blurred a little, and offered a preview of the shitshow to come.
An amendment introduced by Sen. Bernie Sanders of Vermont and Sen. Amy Klobuchar of Minnesota would have allowed imports of prescription drugs from Canada, where they're generally cheaper.
"Let's be clear about it—today Mr. Trump, a guy I don't quote very often, has said that pharma gets away with murder," Sanders said on the floor, as reported by The Hill. "That's what Trump said. He is right. The time has come for us to stand up to the drug companies."
Texas Sen. Ted Cruz–the Republican who in 2013 literally shut down the government because more people were about to get health care and threatened to do so again in 2015 over Medicaid recipients using Planned Parenthood–voted for the amendment. That Ted Cruz.
Cory Booker, a Democrat from New Jersey who appeared to already be positioning himself to run in 2020 with his thunderous testimony against Jeff Sessions on Wednesday, voted against the measure. He was joined by 12 other members of his party, and the amendment failed.
Another amendment to preserve existing protections for birth control coverage and maternity care was rejected, and so was another to protect coverage for people with preexisting conditions.
The amendments were mostly aimed at getting lawmakers on the record as supporting or opposing things like changes that could shut down rural hospitals that will fail without federal funding and the Medicaid expansion, but they were also a kind of mapping exercise to reveal how dismantling one aspect of the health care law can lead to the collapse of infrastructure that's literally keeping people alive.
Rand Paul, the junior senator from Kentucky and failed presidential candidate, was the sole Republican to vote against the budget resolution. The House could vote on the resolution as early as this week, and it's expected to pass.
In a statement after the vote, Senate Majority Leader Mitch McConnell called the vote a "critical step" that “provides the legislative tools necessary to actually repeal this failed law while we move ahead with smarter healthcare policies.”
As the vote went through, people on Twitter with preexisting conditions called it a threat to their livelihoods.