The U.S. House will vote Wednesday on a bill to repeal the Affordable Care Act. The Senate has already passed it, but President Obama has vowed to veto it.

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With a vote this afternoon, Congress is sending a bill to repeal Obamacare and defund Planned Parenthood to the president’s desk. The House has just passed the measure. The Senate has already passed a version. In doing so, many Republican lawmakers are making good on their campaign promises. And yet, no one expects the bill to become law. Joining us to talk about this is NPR’s Congressional correspondent Ailsa Chang. Hey there, Ailsa.

AILSA CHANG, BYLINE: Hey there.

CORNISH: So as we mentioned here, President Obama has vowed to veto this bill. And yet, Republicans spent a great deal of time and energy getting it through Congress. What’s the point?

CHANG: The point of all of this is symbolism, pure and simple. Republicans want a direct confrontation with the president, and putting a bill repealing the health care law on his desk, forcing him to veto it and therefore making him defend the Affordable Care Act and Planned Parenthood, for that matter – that is the end game. What Republicans are trying to do is highlight the contrast between their party and Democrats and to make it clear to voters this year how life might be different under a Republican president with a Republican-led Congress. This is totally about messaging.

CORNISH: Right. But this is not an entirely new message, right? I mean, Republicans have voted dozens of times to repeal the health care law.

CHANG: Yes, but they’ve never been able to show their constituents that they can get the bill to the president’s desk until now. You’re right. In the House, Republicans have voted more than 50 times the last five years to repeal all or parts of the Affordable Care Act, but it’s never been so easy in the Senate because in the Senate, you need 60 votes to pass most legislation. And Republicans have never had that, neither before nor after they took control of the chamber.

But in 2015, what Senate Republicans did have at their disposal was a special legislative process called reconciliation. It’s a procedural tool that allows certain kinds of legislation to get through the Senate with only 51 votes instead of the usual 60. This is actually one of the tools Democrats used to pass the health care law in the first place. Ad now Senate Republicans are using it to repeal the law.

CORNISH: Meanwhile, you know, if President Obama plans to veto this bill, voters aren’t actually going to get to see, like, an alternative health care regime – right? – like, something that Republicans have come up with and put into action.

CHANG: That’s right. Neither the House nor the Senate has ever debated any bill to replace the Affordable Care Act. So what would that replacement look like? You know, Senate majority leader Mitch McConnell famously said that he wants to repeal Obamacare root and branch. But he’s from a state – Kentucky – that’s shown significant improvement to health care access because of Medicaid expansion under this law. In fact, a number of Republican lawmakers are from states that have chosen to expand Medicaid, so the question is, could voters actually stomach it if Republicans really wiped away Obamacare?

CORNISH: All right, Ailsa, so what kind of Republican health care proposals are we likely to see out of Congress this election year?

CHANG: Well, that’s the question that still needs to be answered. House speaker Paul Ryan gave a speech last month at the Library of Congress. And in that speech, he promised to unveil a plan that would replace every word of Obamacare. It would be a plan that’s more driven by free market principles, but so far, no plan has been set forth. Ryan says Republicans can’t just be the party of opposition. They can’t just let the presidential candidates dictate the Republican agenda. But so far, he’s been skimpy on details about what that new agenda would look like. And maybe next week we’ll have some better idea. Republican lawmakers will be meeting in Baltimore for their annual retreat, and perhaps some concrete ideas will be hashed out then.

CORNISH: That’s NPR’s congressional correspondent Ailsa Chang. Ailsa, thanks so much.

CHANG: You’re welcome.

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Musicians who are dealing with mental health and substance abuse problems in Austin, Texas, can get help from an organization there that provides reduced cost care —basically whatever the musicians can afford to pay— from cooperating doctors and therapists.

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A musician’s life can be difficult. Perhaps no place knows this better than the city of Austin, Texas. It’s where thousands of musicians have launched their careers. And for the last 20 years, the city’s community of artists has subsidized mental health care for Austin musicians and their families through something called the SIMS Foundation. It’s named for one of Austin’s young musicians who took his own life. From Austin, NPR’s Wade Goodwyn has more.

(SOUNDBITE OF MUSIC)

WADE GOODWYN, BYLINE: It’s a sold-out show at the KLRU studio. Some of Austin’s finest musicians are here, on the same soundstage where “Austin City Limits” was filmed for decades. It’s a labor of love. They’re donating their time to raise money for an organization that attends to their psychological well-being.

(SOUNDBITE OF SONG, “CROSSFIRE”)

SONYA MOORE: (Singing) Day by day, night after night, blinded by the neon lights.

GOODWYN: Sonya Moore can turn a Stevie Ray Vaughan song into a runaway train of Memphis blues.

(SOUNDBITE OF SONG, “CROSSFIRE”)

MOORE: (Singing) Oh, I got stranded, yeah, caught in the crossfire.

GOODWYN: This astonishing assembly of talent has the power to amaze even veteran Austin musicians like Jimmie Dale Gilmore.

JIMMIE DALE GILMORE: Great music – some of these guys I haven’t heard before – amazing.

(APPLAUSE)

GOODWYN: A country boy from Lubbock, Jimmie Dale Gilmore arrived in Austin back in the early 1970s with his Roy Orbison-like voice and not much else. As tough as it was back then, Gilmore says it’s even harder to make it as a musician today.

GILMORE: Especially because Austin has become more difficult place to live in for musicians ’cause it’s so expensive.

GOODWYN: A 2013 survey revealed that the median income for an Austin musician is around $10,000 a year. That’s where the SIMS foundation comes in. A team of 70 musician-friendly therapists, psychologists and psychiatrists provide mental health services to 600 Austin musicians and their families every year. The providers have lowered their fees to just $50 a session. The musicians pay what they can and SIMS pays the rest. Gilbert Ramos is a SIMS therapist.

GILBERT RAMOS: When I see folks who are starting off in the business, they often come in because there’s some depression, there’s some anxiety, usually related to music life, not getting what it is that they want to get out of the music career.

GOODWYN: Ramos says substance abuse issues are ubiquitous. Bands play in bars. Musicians who sell a lot of drinks get invited back.

RAMOS: Musicians make money the more drinks they sell, and often in order to sell their drinks they have to have something in their hand to drink. It encourages the crowd to do so. That’s one of the little tricks out there.

GOODWYN: Then there are the fans who show their appreciation by offering a hit of this or a line of that. If the crushing poverty and anonymity doesn’t murder a musician’s morale and self-esteem when they’re starting out, perhaps fame and fortune will do the trick.

Austin singer-songwriter Nakia Reynoso, who goes by his first name, had a star run competing on the TV show “The Voice.” He’s ridden this roller coaster for two decades. His song at the SIMS benefit tells his story.

(SOUNDBITE OF NAKIA REYNOSO SONG)

NAKIA REYNOSO: (Singing) I shifted from left to right and back again, searching for my song. But there’s a hole in my heart, got no shape at all. I stuffed with lust and drugs or anything but what really belongs.

GOODWYN: Nakia began seeing a SIMS counselor in 2002 after he’d attempted suicide.

REYNOSO: You know, SIMS saved my life and SIMS keeps me alive.

GOODWYN: Nakia says the therapy he gets every week has kept him from becoming depressed when things go badly. And of course go badly they sometimes do. Nakia says walking out on stage means revealing your most vulnerable self to a judgmental world.

REYNOSO: Here’s my soul. Do you love me? Do you accept to me? Do you want me? I think most of us find ourselves in that position where we’re there to give, but, you know, we want it back.

GOODWYN: A musician’s insecurity is often the touchstone, the driving force of his or her ambition. And the industry feeds off it. Jimmie Dale Gilmore says SIMS speaks to a different set of values – that the making of music is sacred and the makers themselves divine.

GILMORE: The musicians are taking care of each other. It’s really a beautiful thing.

(SOUNDBITE OF MUSIC)

GOODWYN: Wade Goodwyn, NPR News, Austin.

(SOUNDBITE OF SONG, “ANOTHER COLORADO”)

GILMORE: (Singing) Down by the banks of the Colorado, my true love and I one night did lie and we laughed and played and made fun of the entire world spinning ’round the sun down by the banks of the Colorado. Down by the banks of the Colorado, night watchmen stood guard ’round the wagon yard…

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.

When she first heard that California’s new aid in-dying law was signed, Dr. Carin van Zyl was relieved to hear that assisted death would be an option for her if she ever needed it herself. But as a palliative care doctor at the University Of Southern California Keck School Of Medicine, she’s worried the law might lead people to consider lethal medications over other options that may better accommodate their wishes.

“Patients feel as though their choices are between untreated suffering or physician-assisted suicide,” she told NPR’s Renee Montagne. “Palliative medicine, when it’s applied skillfully and at the right time, often relieves most of the suffering that prompts people to ask for [death] in the first place,” she says.

Van Zyl is head of palliative care medicine at Los Angeles County-USC Medical Center. Heidi de Marco/Kaiser Health New/Heidi de Marco/Kaiser Health News hide caption

toggle caption Heidi de Marco/Kaiser Health New/Heidi de Marco/Kaiser Health News

But palliative care, which is focused on managing symptoms and relieving pain, isn’t available to everyone, van Zyl says. There are smaller hospitals that don’t have palliative medicine teams, and it may be hard to get treatment even in urban areas. Van Zyl thinks more work should be done to make palliative medicine more accessible. “I worry that we make [lethal medication] available before we put the necessary effort forward,” she says.

Not everyone can be helped with palliative care, van Zyl says, and some people truly would have benefited from the aid-in-dying law had it been passed earlier. “I think about those patients all the time. I do recall a patient who understood that his death would be sudden and unpredictable and likely quite painful.”

He had a cancer that had spread and become intractable. A tumor developed in his neck that was swelling into both an artery and his windpipe; eventually it would connect the two. “This gentleman with very little warning might have his airways flooded with blood, and he would drown,” van Zyl says. “He asked if it would be possible to shorten his life before that.”

The care team was able to administer pain medication that would ease his death when it happened, which worked, van Zyl says, but he wasn’t able to die in the way he wanted — at home, surrounded by his family. Aid in dying would have offered more control over his situation, van Zyl says.

Still, the reasons why people choose aid in dying can be complicated. “You’ll notice in the Oregon data, many people chose this option not because of physical suffering. It was the loss of dignity, control and independence,” she says. “I would imagine writing a prescription for somebody for whom palliative sedation is not an option or would not relieve intolerable physical distress. I struggle with emotional and existential requests.” Times like that, van Zyl says she would rather administer palliative care.

Dr. Carin van Zyl talks to patient Jose Garcia Flores about his treatment options for his advanced stage colon cancer in October. Heidi de Marco/Kaiser Health New/Heidi de Marco/Kaiser Health News hide caption

toggle caption Heidi de Marco/Kaiser Health New/Heidi de Marco/Kaiser Health News

Choosing the best course of action is a conversation that van Zyl says she’ll continue to have with her patients. “Palliative medicine discussions are about learning the story of the person, helping this patient navigate choices. If [death] is an option that gets them closest to the things they hold dearest, then we will explore those things honestly.”