Senate Republicans have at least narrowed the options on what comes next for the Affordable Care Act — casting two separate votes since Tuesday that knocked out a “repeal-only” proposal and rejected a plan for replacement.

So, as lawmakers resume debate on Thursday, they will be staring at basically one possibility: a so-called “skinny repeal” that would surgically remove some key provisions from Obamacare, while leaving the rest intact — at least for now.

The skinny repeal would take out requirements for individuals and employers to get health insurance — a feature that is central to the Affordable Care Act’s goal of expanding risk pools and lowering costs. The GOP plan would get rid of the medical device tax, intended as a revenue source to fund the current health law. The proposal would also eliminate a public health fund provision.

Senators have already rejected the Better Care Reconciliation Act replacement plan and a repeal-only proposal so far. The nonpartisan Congressional Budget Office has said the Better Care Reconciliation Act would have left 22 million more people uninsured by 2026, whereas simply repealing Obamacare without an immediate replacement would have resulted in 32 million more without health care insurance in the same time frame. The CBO estimated on Wednesday, at the request of Democrats, that a skinny repeal could result in 16 million more uninsured.

Nine GOP senators said no to the Better Care Reconciliation Act on Tuesday: Susan Collins of Maine, Tom Cotton of Arkansas, Bob Corker of Tennessee, Lindsey Graham of South Carolina, Dean Heller of Nevada, Mike Lee of Utah, Jerry Moran of Kansas, Lisa Murkowski of Alaska and Rand Paul of Kentucky.

Earlier attempts to get that bill to the floor were stalled by a lack of support.

Collins and Murkowski, who voted Tuesday against even proceeding to debate, also came out against the repeal-only proposal on Wednesday. They were joined by Republicans Heller, Shelley Moore Capito of West Virginia, John McCain of Arizona, Rob Portman of Ohio and Lamar Alexander of Tennessee.

“I’m for repeal and replace, and we’re going to continue to work on replacement,” Portman said after Wednesday’s vote.

The ultimate outcome of both votes had been a foregone conclusion, says NPR’s Susan Davis. “This was really an exercise about forcing senators to lay their cards down on the table,” she tells All Things Considered. “We didn’t know where a lot of these senators were as a hard yes or no.”

As the debate moves forward, the Senate’s skinny repeal could be completely rewritten through the amendment process — and that is likely to play out over the next week, says Davis.

Republicans and Democrats alike will be able to offer unlimited amendments, as long as they’re germane to health care. “We expect hundreds of them will be offered to the bill. They will be whittled down from there,” Davis says. It’s a process known in the Senate as “vote-a-rama.”

Once that happens, Senate Majority Leader Mitch McConnell will need to take stock again to see which GOP senators he needs to get in line in order to pass a fully amended skinny repeal.

“The working strategy for Republicans is to get a lowest-common denominator — something they can all agree on in order to get enough support to move it to a conference committee,” where differences would have to be settled with the House, Davis says. Throughout the health care debate, Republican leadership has faced disagreement from both moderate and conservative members about how to proceed.

Democrats, meanwhile, are universally opposed to both measures and therefore sidelined in the debate. But one amendment proposed by Sen. Steve Daines, R-Mont., calls for a single-payer system — a move designed to get Democrats on the record. Some — such as Vermont independent Sen. Bernie Sanders, who typically caucuses with Democrats — would be happy to support the measure, whereas others facing tough re-election battles in 2018 might be less enthusiastic.

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In the seven years since the Affordable Care Act was passed, CEOs of U.S. health care companies have made a lot of money.

Their compensation far outstrips the wage growth of nearly all Americans, according to reporter Bob Herman, who published an analysis this week of “the sky-high pay of health care CEOs” for the online news site, Axios.

Based on corporate financial filings with the Securities and Exchange Commission, Herman did research on 113 heads of 70 of the largest U.S. health care companies in the last seven years. Cumulatively, he says, these CEOs have earned $9.8 billion since the ACA was first enacted. Only four of the 113 CEOs were women, he notes, and only two are right now in charge of major health care companies.

The top earner was John Martin, the former CEO of the pharmaceutical company Gilead Sciences, who took home nearly $900 million, Herman says. Gilead makes, among other things, medicines to treat HIV and AIDS, as well as two leading drugs to treat hepatitis C.

Several other executives topped $250 million.

Robert Siegel, host of NPR’s All Things Considered, spoke with Herman about his analysis. Excerpts of the interview follow, edited for length and clarity.

Interview Highlights

Who are these CEOs and why are they earning so much money — on average, $20 million per year, you say?

We looked at a wide array of different companies. They include pharmaceutical companies, health insurers, hospitals, pharmacies — it really spans the gamut. And we found that since the Affordable Care Act went into effect in 2010, their pay has really gone up. So the ACA hasn’t really hurt their earnings, per se. And a lot of the money that they’re earning is coming in the form of vested stocks.

Of course, an underlying issue behind all the talk about Obamacare is not just how we pay for health care and who gets insurance (and in what form) to pay for health care, but how much we pay for health care. What do these CEOs’ earnings say about health care costs in the United States?

For the longest time, health care inflation has really blown away the rate at which the rest of the economy is growing. And a big reason why is because health care executives are not paid to slow spending. Because so much of their pay comes in the form of stock, their incentive is to do whatever it takes to make that stock go up. So that means selling more drugs; raising prices above inflation; performing more procedures; getting more people into the hospital. And those are the exact opposite things that health policy experts believe would benefit the broader system: lower prices; eliminating unnecessary care and drugs; coordinating better care.

But from 2010 (when the Affordable Care Act was signed) through 2015, the Dow Jones went up from under 11,000 to almost 18,000. Wouldn’t executives in most sectors of the economy be making huge gains on stocks and stock options during the period that is also the lifetime of Obamacare?

The stock market really has been doing quite well since the Affordable Care Act has gone into effect, but the reason why this matters even more for health care is a sixth of our economy is devoted to health care. And that continues to grow more every year. So if the most influential executives of these companies are being paid to keep that trajectory up, that’s money that’s being taken away from education or infrastructure or other parts of the economy that may not be growing as quickly, and maybe that we’d want to grow more quickly.

Can a health care executive argue that the Affordable Care Act brought a lot of people into coverage who haven’t had it before? We’ve heard this anecdotally — that lots of people are getting treatment for things that they were skipping when they couldn’t afford it. So, more people are going to the doctor; they’re getting more prescriptions.

There is some effect there, but that doesn’t account for everything. The underlying incentives still really push these companies to do more — even if it’s unnecessary. There’s still this big issue of all these services that people are getting, are they necessary? And I think that’s one of the questions that still need to be answered.

Are there any proposals on the table now — either in Republican bills or in Democratic proposals — that would actually reduce health care costs significantly and reverse this trend?

In the health care debate right now, none of the proposals in Congress address this whatsoever. A lot of what’s being proposed merely tinkers with the financing of health care and who gets health insurance. Nothing is being addressed about drug prices, for example. Nothing’s being addressed about the actual costs of the system. The debate right now is still bickering over how to finance the system — not around how much the system itself costs, which I think is a big issue.

NPR editors Renita Jablonski and Gisele Grayson, and producer Ian Stewart contributed to this story.

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The Senate has another day of debate on healthcare. Tuesday a repeal and replace proposal fell short of the votes needed to pass and on Wednesday, lawmakers will take a vote on a repeal only option.

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In the neonatal intensive care unit of Cook Children’s Hospital in Fort Worth, Texas, a father is rocking a baby attached to a heart monitor. While doctors roam the halls trying to prevent infections, Chief Information Officer Theresa Meadows is worried about another kind of virus.

“The last thing anybody wants to happen in their organization is have all their heart monitors disabled or all of their IV pumps that provide medication to a patient disabled,” Meadows says.

Meadows manages IT and cybersecurity for nearly 7,000 employees at more than 50 locations in Texas. After co-chairing an evaluation of hospital cybersecurity across the U.S., she says there’s a lot to improve.

Dr. John Halamka, chief information officer of Beth Israel Deaconess Medical Center in Boston, agrees. “Health care has traditionally underinvested in information technology,” Halamka says.

Halamka, who has been a CIO since the 1990s, says just a decade ago, pretty much all health records were paper. Then, in a period of a few years, hospitals switched to electronic records. But the security of digital health data has not kept up with its growth. Other industries, like financial services and the federal government, have devoted more than 12 percent of their IT budgets to cybersecurity. Health care averages just half that.

At the same time, the cost of mitigation has soared, with the average breach costing $355 per stolen record for health care organizations. And hackers have gotten creative. Back in 1997, Halamka says, the threats he faced were students trying to hack the network.

“In 2017, what threats do I face? State-sponsored cyberterrorism, organized crime and hacktivism.”

It’s no wonder demand for cybersecurity talent in health care has exploded. But it’s not that easy to recruit.

Digital health care consultant Drexel DeFord jokes that he’s a “recovering CIO. CIOs are overly stressed with everything from security to regulation,” he says. “When I talk to them about maybe coming into health care, the answer I usually get is ‘No way, it’s too complicated. It’s way simpler to do banking or oil and gas.’ “

It’s also much more lucrative to work in other industries. According to Burning Glass Technologies, the average advertised pay for health care cybersecurity positions is 25 percent lower than in finance.

Plus you’re on the line every minute, not just for keeping someone’s social media profile working, but for helping keep them alive.

Meadows says a good CIO is familiar with complex medical devices and comfortable with software and complicated regulations. Also, a CIO needs to keep the hospital staff educated on the latest threats, sometimes by running mock cyberattacks. Meadows conducts regular phishing exercises paired with educational campaigns.

The average cost of a health care breach is estimated to be more than $2.2 million, not to mention the reputation damage. Meadows says the price of hiring a cybersecurity leader might seem high, but leaving the job open is an invitation for trouble.

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The Senate has voted to debate their measures on health care overhaul. Steve Inskeep talks with reporter Noam Levey of the Los Angeles Times about the latest.

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NPR’s Robert Siegel talks with Sen. Angus King, Independent of Maine, who voted on Tuesday against an effort to start discussing a bill to reset the Affordable Care Act.

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Sen. John McCain — who was recently diagnosed with brain cancer — made a dramatic return to the Senate Tuesday and voted yes in the GOP effort to dismantle the Affordable Care Act.

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The Senate voted Tuesday to begin debating a replacement for the Affordable Care Act. It remains uncertain as to what that replacement might look like. No formal legislation has been drafted. But senators moved to take the procedural first step, known as a “motion to proceed.” The vote was 51-50, with Vice President Pence casting the tiebreaking vote.

Debate will now begin, most likely on a measure to fully repeal the law, also known as Obamacare.

With all Democrats opposing the measure, Senate Republican Leader Mitch McConnell could afford only to lose two votes from his 52-vote majority and two GOP senators did vote no, Maine’s Susan Collins and Alaska’s Lisa Murkowski.

There was more drama. The vote marked the return of Sen. John McCain, the Arizona Republican whose brain cancer diagnosis stunned his colleagues. He was greeted with a standing ovation on the Senate floor and was embraced by senators from both sides of the aisle. McCain then voted yes on the motion.

President Trump, speaking at a news conference with Lebanese Prime Minister Saad al-Hariri in the Rose Garden, pronounced himself “extremely happy” and predicted, “We’re going to come up with a plan that’s really, really wonderful for the American people.” He also thanked McCain for coming for the vote.

Before voting began, a group of protesters shouted “kill the bill'” and “shame” from the Senate’s galleries.

With debate formally opened, senators will be able to freely offer amendments, so nobody knows what the final product will look like. It’s an unusual and perhaps unprecedented way to draft a bill that will affect millions of Americans and a large chunk of the economy, to say the least. But McConnell said after the vote that “we’ll finish at the end of the week.”

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President Trump pressures Senate Republicans to keep their promise to repeal and replace the Affordable Care Act. In Turkey, 17 journalists from the country’s oldest independent newspaper go on trial.

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Nurse-Family Partnership programs provide low-income mothers with checkups. Robert Siegel speaks with Nobel Laureate James Heckman on the benefits of NFP, which is found to especially help boys.

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