This week has the potential to be the most important of the year in healthcare, as the Senate could vote as early as Thursday evening on their version of a bill to repeal and replace major provisions of the Affordable Care Act (ACA). Majority Leader Mitch McConnell (R-KY) will likely bring the bill to the floor soon after the release of the Congressional Budget Office’s (CBO) score, which is expected early this week. Before any votes can be cast, the legislation will also need to undergo a review from the Senate parliamentarian to decide which provisions, if any, violate the chamber’s budget reconciliation rules. One of the key unknowns still remaining is whether a process for states to waive essential health benefits and other market reforms will survive the Senate parliamentarian’s analysis. The waiver process was added to the House’s version of the bill as an amendment from Rep. Tom Macarthur (R-NJ) and was essential to the American Health Care Act’s (AHCA) approval in the lower chamber.

The Senate’s version of a health care overhaul was released with a great deal of fanfare yesterday as supporters and detractors of the bill quickly tried to establish their positions on the bill. The most significant development came yesterday afternoon when four conservative Republican senators — Sens. Rand Paul (R-KY), Ron Johnson (R-WI), Ted Cruz (R-TX), and Mike Lee (R-AZ) — announced that they are opposed to the bill in its current form; although they were sure to add the caveat that they are “open to negotiation and obtaining more information before it is brought to the floor.” President Trump threw his support behind the Senate draft this morning in an interview on Fox & Friends and seemed open to placating the conservatives, saying “They’d like to get certain changes, and we’ll see if we can take care of that.”

The product of weeks of negotiation is set to be unveiled today when Senate Majority Leader Mitch McConnell (R-KY) releases a “discussion draft” of the Senate’s version of a health care overhaul to replace the Affordable Care Act (ACA). The Majority Leader is hosting an all-caucus meeting at 9:30am this morning to present the plan to Republicans, many of whom have said they hadn’t seen the text as of yesterday. Nevertheless, the overarching plan of the bill is understood to be similar to the House version, which included a significant cut to Medicaid funding, elimination of the ACA’s individual and employer mandates, and repeal of most of the ACA taxes, among other provisions. Key differences in the Senate version are expected to include linking insurance subsidies to income-level rather than age, curtailing the Medicaid expansion at a more gradual rate than proposed under the House’s American Health Care Act (AHCA), and linking federal spending under the Medicaid per-capita caps to a slower growth index than the one included in the AHCA (portending larger long-term cuts).

President Trump and Republican leaders were able to breathe a sigh of relief last night as election returns came in from two special elections — in Georgia’s 6^th district and South Carolina’s 5^th district — showing GOP holds in both seats, albeit by relatively narrow margins. In the more prominent of the two races, Republican Karen Handel bested Democrat Jon Ossoff in the most expensive race ever run in the House of Representatives, where Democrats were hoping a win could demonstrate momentum in their efforts to block the Republican legislative agenda. Instead, the Republican wins could prove to be a boon for their legislative initiatives on health care and tax reform.  

After weeks of negotiation, Senate Republicans appear to be closing on the legislative text for its version of a healthcare overhaul, with the aim of holding a vote before the end of next week. The components of the Senate bill have reportedly been sent to Congressional Budget Office (CBO), who will need to release a score of the bill before the Senate can vote on it. Similar to the process in the House, there is no firm vote count on the bill and the eventual floor vote is likely to be dramatic – and close. Republicans will need to avoid three defections from their ranks in order to pass the bill, although Leadership appears serious in its intent to hold a vote regardless of whether a victory is ensured. Defeat in the Senate would likely forestall health care reform for the foreseeable future as Republican lawmakers are reportedly eager to move on to tax reform. 

As the summer churns along, Republican leaders are hoping to break the stalemate on their major priorities, namely health care legislation, tax reform, and the appropriations process for the 2018 fiscal year. All three appear to be deadlocked at the moment, with health care reform at the front of the queue. According to a report yesterday from Axios, Senate Majority Leader Mitch McConnell (R-KY) is hoping to force a vote on the Senate’s version of health care reform – which has yet to be publicly released – as early as next week. That move would require legislative text to be sent to the Congressional Budget Office (CBO) in order to be scored, meaning that negotiations would need to be finished this week. The remaining sticking points are well-known – Medicaid funding and the degree to which the bill will roll back restraints put on the insurance market by the Affordable Care Act (ACA) – but a formal whip count remains elusive as senators await legislative text.