February 7, 2023

The amendment process, known on Capitol Hill as the “Rama vote,” began Saturday night shortly after 11:30 p.m. ET. A final vote on the bill will take place when voting on the amendment ends, and it is not clear when.

The package is the product of painstaking negotiations and will give Democrats a chance to achieve key policy goals before the upcoming midterm elections. Senate Democrats use a special process to pass the bill without Republican votes.

Once the legislation passes in the Senate, it will then need House approval before President Joe Biden can sign it into law. The House is preparing to return to consider the legislation Friday, according to the office of House Majority Leader Steny Hoyer.

Senate Democrats need only a simple majority for final approval of the bill because they use a process known as conciliation, which allows them to avoid Republican obstruction and the corresponding 60-vote threshold.

In order for a bill to pass through the settlement process, the package must comply with a strict set of budget rules. Republicans use the “rama vote” system to put Democrats in the lead and impose politically difficult votes.

As expected, key insulin articles were removed from the bill after Republicans raised a point of order, leading to a vote to withdraw them.

The final vote was 57-43. A threshold of 60 votes was needed to keep the ruling in place.

Provisions included in the bill will initially set insulin prices to $35 a month both in the private insurance marketplace as well as through Medicare. But the senator ruled that the cap on insulin in the private insurance market was inconsistent with the conciliation rules Democrats use to push their legislation through the House.

Democrats kept both articles in the bill anyway, but Republicans raised a point of order to force a vote to strip items only from the private market. The $35 insulin cap from Medicare is still in place.

CNN’s Manu Raju and Kristen Wilson contributed to this report.

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