Senate Republicans must decide in the next few weeks whether to repeal (and “replace”) the Affordable Care Act, because:
1. Republicans can only pass their health bill through a special budget process called "reconciliation," which allows them to avoid a Democratic filibuster and pass the legislation with 50 Senate votes (and a tiebreaking vote from Vice President Mike Pence). They also want to use the same budget procedure to pass big tax cuts for the wealthy and for corporations. But Senate rules allow only one such "reconciliation" maneuver at a time. Which means their tax plan can’t move forward as long as health care drags on.
2. The current Senate health bill includes substantial tax cuts for the wealthy and several hundred billion dollars in projected savings. If that bill isn't going to become law, it would alter the choices about which taxes get cut as part of the tax-only bill.
3. If health reform isn’t wrapped up by the end of the month, it bumps up against Congress’s scheduled summer recess.
4. Several other bills are likely to take priority in the weeks after the summer recess – raising the debt ceiling, reauthorizing the Children’s Health Insurance Program, and passing new bills to fund government functions.
5. The Republican health bill is attached to a budget for the 2017 fiscal year, which ends Sept. 30. If they haven't passed their bill by then, Republicans have to start from scratch by passing a new budget for 2018 with instructions to reform the health system, and passing a health care bill through the House again.
6. McConnell is already losing Republican votes, and any additional delay will lose him more. During last week’s July 4 recess, several crucial Republica senators heard criticisms of the bill and voiced strong critiques. Consensus is weakening even as the time pressures build.
It's too early to assume McConnell's bill is dead, but it's on life support.