Congress returns from the July Fourth recess focused on negotiations over the Better Care Reconciliation Act (BCRA) of 2017 — legislation to repeal and replace the Affordable Care Act (ACA), but it is unlikely a Senate vote on the bill will be scheduled for several weeks.

Senate Republican leadership continues to negotiate with Republican holdouts who are undecided or have publicly denounced the bill. Leadership is expected to push a vote on the bill before the month-long August recess.

The Congressional Budget Office (CBO) found that the bill would lead to 22 million fewer insured and cut more than $772 billion from Medicaid over 10 years. Following the initial scoring of the BCRA, CBO also said the BCRA would lead to federal Medicaid funding cuts of 35 percent over the next 20 years.

During the July Fourth recess, CBO began analyzing revisions to the bill that would create parallel health insurance markets in states — one containing protections for essential health benefits and people with pre-existing conditions, and one allowing the sale of narrower plans, likely without federal subsidies. It is uncertain whether such proposals would qualify under budget reconciliation rules.

Senate leaders said they intend to release an updated version of the BCRA this week.