Congress’ seven-month effort to repeal and replace the Affordable Care Act (ACA) ground to a halt last week when the Senate was unable to pass three separate repeal proposals.

The Senate first voted down the Better Care Reconciliation Act (BCRA) of 2017, its alternative to the House-passed American Health Care Act. Senators then rejected the Obamacare Repeal and Reconciliation Act (ORRA), which would have repealed much of ACA without enacting a replacement. The Senate’s last-ditch effort to repeal, a “skinny” amendment to the ORRA, failed 49-51 when Sens. Susan Collins (R-ME), John McCain (R-AZ), and Lisa Murkowski (R-AK) voted against the measure. The stunning rejection effectively ended consideration of ACA repeal for now, as Congress likely has too little time to resolve its differences before a Sept. 30 deadline to pass legislation under budget reconciliation rules. America’s Essential Hospitals released a statement on the Senate’s rejection of ACA repeal legislation.

Following the failure of the repeal efforts, the Trump administration began working with the Department of Health and Human Services to consider its options on continued funding of cost-sharing reduction (CSR) payments to insurers, which are critical to keeping the ACA marketplace stable. The administration could come to a decision this week on CSR payments, which help insurers reduce deductibles and other out-of-pocket costs for low-income people. If CSRs are defunded, the individual market likely would collapse and premiums could increase by up to 20 percent to compensate for the loss.

Some Policymakers Remain Focused on ACA Repeal

Some Senators have not given up on repealing the ACA. Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) are working to craft an alternative repeal bill with the goal of garnering support from at least 50 senators.

Other members of Congress appear eager to seek bipartisan solutions. Reps. Tom Reed (R-NY) and Josh Gottheimer (D-NJ) are leading a bipartisan group of more than 40 House members to craft legislation to shore up the individual marketplace. Like the Graham-Cassidy bill, their legislation is not yet ready for consideration.