Senate unlikely to vote on ACA repeal until week of July 17

After failing to meet their self-imposed June 30 deadline to vote on the Better Care Reconciliation Act (BCRA), Senate Republicans now say they’ll need another week in Washington before the bill may advance.

Senators and White House officials have told POLITICO there won’t be any healthcare vote when Congress reconvenes after a weeklong recess. More work needs to be done, they said, on bringing together different factions in the Republican caucus.

Conservatives like Sen. Rand Paul, R-Kentucky, want greater deregulation and argue the current legislation leaves too much of the Affordable Care Act (ACA) in place. Moderates like Sens. Dean Heller, R-Nevada, and Susan Collins, R-Maine, have said they can’t support the bill due to its impact on Medicaid funding—a 35 percent cut compared to the ACA by 2036, according to the Congressional Budget Office (CBO).

To garner greater support from those groups, there have been proposals to add funding to fight opioid abuse, leaving some ACA taxes in place and allowing health savings accounts to go to premiums. Some of those proposals have angered conservatives, with Paul calling it a “Christmas tree full of billion-dollar ornaments” in a Fox News interview. They also haven’t appeared to sway moderates like Collins into the “yes” column.

“What I've been hearing the entire recess is people telling me to be strong, that they have a lot of concerns about the health care bill in the Senate, they want me to keep working on it, but they don't want me to support it in its current form," Collins told reporters at a July 4 parade in Eastport, Maine.

One potential change geared towards conservatives—an amendment from Sens. Ted Cruz, R-Texas, and Mike Lee, R-Utah, to allow insurers to sell plans free of ACA benefit requirements—is currently being analyzed by the CBO, with a report expected next week. The first CBO report on the legislation said BCRA would increase the number of uninsured Americans by 22 million, raise out-of-pocket spending and destabilize the individual market in some parts of the U.S.