The past 24 hours in health care, explained

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This is the web version of VoxCare, a daily newsletter from Vox on the latest twists and turns in America’s health care debate. Like what you’re reading? Sign up to get VoxCare in your inbox here.

The Better Care Reconciliation Act is dead. A clean (partial) Obamacare repeal bill is dead. Barring a miraculous resurrection, Senate Republicans’ hopes of passing a major health care overhaul are dead.

It was an outcome months in the making, founded in the bitter divide between conservatives and moderates on how exactly to unwind the 2010 health care law they’d spent years opposing.

But the demise happened very quickly. We started Monday expecting a relatively slow week, after Sen. John McCain’s health scare delayed any further action on the BCRA for the time being.

You’ll never guess what happened next.

8:30 pm Monday: Sens. Mike Lee (R-UT) and Jerry Moran (R-KS) announce they will oppose the current version of the BCRA, bringing the number of opposing senators to four, enoughto block the bill.

10:48 pm Monday: Senate Majority Leader Mitch McConnell shelves the BCRA and announces Senate Republicans will instead set up a vote on an updated version of the 2015 budget reconciliation bill that partially repeals Obamacare with a two-year delay.

10:03 am Tuesday: McConnell puts pressure on his members, noting that Senate Republicans passed the partial repeal bill just two years ago. “A majority of the Senate voted to pass the same repeal legislation. President Obama vetoed it then. President Trump will sign it now,” he says.

10:35 am Tuesday: Sen. Susan Collins (R-ME), the only Republican to oppose the 2015 bill, tells NBC News she will vote against it again.

11:11 am Tuesday: Sen. Shelley Moore Capito (R-WV) says she will oppose the procedural vote to open debate for the repeal-without-replacement legislation. “I didn’t come to Washington to hurt people,” she says. With McCain out of town, the partial bill lacks votes to advance, at least until he returns.

12:36 pm Tuesday: Sen. Lisa Murkowski (R-AK) tells reporters she would also vote to block the partial repeal bill from advancing. “If we’re going to do repeal, there has to be replacement,” she says. Collins, Capito, and Murkowski are enough votes to block the bill, even once McCain returns to Washington.

2:32 pm Tuesday: McConnell announces that Senate Republicans will nevertheless vote to start debate to move forward with the partial repeal bill in the near future. But unless one of the current opponents changes his or her mind, that vote will not have the support to pass.

3:28 pm Tuesday: Sen. Lamar Alexander (R-TN), chair of the Senate health committee, announces he will hold hearings on the individual market after the Senate votes — a signal that Republican leaders might be prepared for the partial repeal bill to fail.

Chart of the Day

NICHM Foundation

The big spenders in health care. It’s a truism in health care that a small number of people account for a big chunk of the spending. This chart puts that into sharp relief: The top 1 percent of spenders account for 20 percent of spending, and the top 5 percent for nearly 50 percent. Read more from Sarah on America’s health care cost problem.

Kliff’s Notes

With research help from Caitlin Davis

Today’s top news

  • “House GOP boils over in anger after Senate failure on healthcare”: “House Republicans on Tuesday were seething with anger over the Senate GOP’s late Monday decision to pull the plug on a bill to repeal and replace Obamacare.” —Susan Ferrechio, Washington Examiner
  • “Dem leaders amp up calls for bipartisan ObamaCare fixes”: “Fueled by the Senate Republicans’ failure to repeal and replace the Affordable Care Act, Democrats are ramping up their calls for GOP leaders to reach across the aisle in search of bipartisan fixes to former President Barack Obama’s signature domestic achievement.” —Mike Lillis, the Hill
  • “11 GOP and Dem Governors issue joint statement on health care”: “A bipartisan group of governors issued a joint statement Tuesday urging the Senate to ‘immediately reject efforts’ to repeal the Affordable Care Act and instead have both parties come together and focus on fixing America’s unstable insurance markets.” —Alayna Treene, Axios

Analysis and longer reads

  • “With collapse of GOP health care effort, Congress faces a long ‘to-do’ list for health policy”: “Whatever they do, Republicans are starting from scratch on a whole host of major policy changes — with deadlines looming increasingly close. Here’s a deeper dive into Congress’s health care to-do list for 2017.” —Erin Mershon and Lev Facher, STAT
  • “7 uncomfortable truths for Republicans in the wake of the health care collapse”:“Talk to any Republican privately and they will tell you that there are simply no good options to turn this legislative lemon into lemonade. Below are seven hard realities Republicans need to face in the aftermath of this epic collapse.” —Chris Cillizza, CNN
  • “GOP health bill nears demise, but Democrats’ unity masks their own dangerous divide”: “Democrats showed uncommon unity in fighting Republican efforts to repeal and replace the Affordable Care Act, and it appeared to be working Monday as two more GOP senators said they can’t support the latest version. But Democrats’ discipline masks a deep and fundamental divide within the party that could complicate efforts to gain ground in the 2018 election and beyond.” —Lesley Clark, McClatchy
  • [Source”cnbc”]