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Health care state of play: The votes aren't there yet. But there will (probably) be a vote

What senators hoped would be a clarifying Tuesday turned out to be a chaotic Tuesday.

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MJ LeeLauren Fox
Ted Barrett (CNN)

What senators hoped would be a clarifying Tuesday turned out to be a chaotic Tuesday.

Health care discussions were overtaken by the latest Russia bombshell, and members coming out of the Tuesday luncheon made clear that the votes still aren't there, and more importantly, that it's not yet clear how this bill will pass.

But despite the continued confusion and skepticism, Senate Majority Leader Mitch McConnell is moving full steam ahead. In fact, he is raising the stakes: he's delayed the start of August recess precisely for the stated purpose of tackling important legislative priorities "once the Senate concludes its work on health care reform."

Timeline (confirmed by McConnell)

Thursday: Draft bill(s) released.

Early next week: CBO score(s) released.

Mid-next week: Vote on motion to proceed.*

*This is not to be confused on a vote on the bill itself. This is just the first procedural step that would start debate on the bill.

And an important reminder on this: If this bill looks like it's going to fail, the "no" Republicans will want to kill it on the motion to proceed. This will save them from going through the vote-a-rama, when Democrats offer many politically tough amendments for Republicans to vote on.

Why "bill(s)" and "scores(s)"?

Senators walked out of their Tuesday lunches believing that they could be seeing double.

On Thursday, it's possible that there will be two draft bills released -- one with Ted Cruz's amendment (which conservatives like), and one without, according Sen. Bob Corker of Tennessee. The Cruz amendment would allow insurers that offer Obamacare policies to also offer cheaper, stripped-down policies unregulated by the law.

Similarly, early next week, we could get two Congressional Budget Office scores: one with the Cruz amendment, and one without, according to Sen. Bill Cassidy of Louisiana.

RELATED: Ted Cruz's Obamacare repeal plan would cripple the market say experts

Prior to July 4 recess, various bills were submitted to CBO for scoring (so that the office would be ready to release an updated score as quickly as possible). What was less expected, however, was the possibility that leadership could be undecided between two bills so close to a vote, and present the conference with multiple versions.

What will be in the revised bill?

Cruz amendment aside, here's what else we know about what's expected to be in the new bill:

$45 billion for opioid addition treatment, according to Sen. John Cornyn, the Senate's GOP whipMore money for stabilization funds No big changes to Medicaid expected Taxes on wealthy Americans won't be repealed -- they will stay (This is politically significant -- Republicans were getting a ton of heat for initially proposing to repeal these taxes)

What is Lindsey Graham up to?

Apparently, Sen. Lindsey Graham of South Carolina is working on an "alternative" health care plan of his own. He told reporters Tuesday that he is developing a proposal with several of his colleagues -- and even trying to woo Democrats -- though he wouldn't share what exactly that proposal looks like.

"I want to do the best I can and I think the best we can is not on the table right now," he said.

He noted it would likely be an amendment to the current bill, rather than a new bill. A Democratic aide says he's also reached out to senators across the aisle to discuss this.

What are the Democrats conveying to Graham? "Abandon the repeal bill that cuts taxes for the wealthy and Medicaid, and we're eager to work with you," a senior Democratic aide said.

If Graham is working on an amendment, that means we're still talking about the reconciliation process, which requires just a simple majority (50) for passage. Congressional observers should still be skeptical about the bipartisan talk around this Graham bill. Democrats have been very, very clear: they will not work with Republicans on anything resembling an Obamacare repeal bill. Anything that's a bipartisan health care effort will have to go through regular process (committee hearings, debate, requiring 60 votes) -- and if Graham is working on an amendment to the current bill, this is not that.

OK, so how does this end?

Here's where it looks like we are headed as of now. There still are not 50 votes in sight. Conservatives have demands, moderates like Susan Collins and Lisa Murkowski have demands, and Sen. Rob Portman is fighting back against the decision to make major cuts to Medicaid in the long term. None of those problems have been solved yet and assuaging the concerns of one faction only alienates another.

Right now, it doesn't even seem like they have the votes to pass a motion to proceed and there is no reason to put members through a marathon vote-a-rama if the bill is ultimately going to go down in smoke. That said, anything can happen here. McConnell delayed recess -- things are getting crazy up here.

Here are the ways this could end:

McConnell could get to next week, see the votes still aren't there and decide not to have a vote (that is what happened two weeks ago)

McConnell could hold the vote, dare members to vote no and members could vote against the "motion to proceed" and never get onto the bill. McConnell could hold the vote, members could get onto the bill, we have a vote-a-rama and then the bill fails

McConnell could hold the vote, members get onto the bill, we have a vote-a-rama and then it passes.

What is happening behind the scenes? Byrd Bath!

It's Byrd Bath time. This process has been ongoing, but Republicans and Democrats are debating behind closed doors what actually can be included in the health care bill under those special set of reconciliation rules.

Republican health care plans: Understanding the 'Byrd Bath'

Remember, reconciliation is the process that lets Republicans pass the health care bill with just a simple majority. But, there are rules attached. Basically, staff is debating the merits of each provision before this bill goes to the floor.

Things that could come out of the GOP health care bill during this process? Two things everyone is talking about are the Planned Parenthood defund and any regulatory changes. Also a hot topic is whether Cruz's amendment is allowed under Byrd.

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