If it’s December, it must be time for a massive, one-time, all-or-nothing annual spending bill. That’s just what has become of Congress’s core function over the past decade. This year’s version includes a 2,009 page omnibus appropriations bill and a 233 page tax bill mostly extending various “temporary” tax preferences and other provisions.

Republicans have majorities in both houses, so this bill reflects their priorities on the whole. But on health care, it’s actually most interesting for what it suggests about the Democrats—some meaningful number of whose votes are after all necessary for passage.