Republican officials are unable to come to a consensus on the Senate health care bill, creating challenges and conflict that may result in an inability to repeal the Affordable Care Act.

While conservative Republicans call for reduced regulations, moderates are focused on maintaining insurance for people who received coverage under Medicaid expansion. Though no agreement has been reached, Senate Republicans intend to start debating amendments to the health care bill next week.

About the Senate Health Care Bill

On Thursday, Senate Republicans published a revision of a health care proposal intended to replace the Affordable Care Act. An initial version of the repeal was passed in the House on May 4.

Opponents say the legislature breaks down Congressional programs that have expanded health insurance in the last 50 years. A minimum of 50, out of 52, Republican senators must approve the bill for it to pass. If the vote does happen, it may be affected by Senator John McCain’s cancer-related absence. 

Though the legislation would lower premiums and allow insurance companies to sell less expensive policies, some argue it would strip down benefits and leave millions without coverage. For some low-income Americans, premiums offset by higher deductibles could skyrocket out-of-pocket costs and make insurance unaffordable.

The bill included compromises that differed from the version passed in the House. It maintained a 3.8 percent investment income tax and a .9 percent payroll tax for high-income Americans earning more than $200,000 and couples earning more than $250,000. It also allowed for tax health savings accounts and allocated $45 billion for opioid abuse programs.

Moderate Republicans remain concerned about caps to Medicaid spending, which supports low-income earners, people receiving care in rural hospitals, and seniors in nursing facilities.

Why The Senate Healthcare Bill May Fail

An article in the New York Times summarized the bill’s failure as a consequence of “deep divisions within the party,” “a lack of a viable health care alternative” and difficulties from the president.

After the draft of the bill was released, Republican senators broke into two distinct groups: Conservatives who want to cut Medicaid and moderates who don’t. On top of party-wide divisions, the bill wasn’t supported by health care professionals, insurance companies or patient advocates.

Senator Mitch McConnell (R-KY) proposed repealing the Affordable Care Act now and developing a revision within two years. The Congressional Budget Office, comprised of nonpartisan analysts, argued that a repeal could leave 15 million uninsured next year. The number would increase to 22 million in 2026.

For senators who intend on debating the bill next week, it will be a challenge to address the issues without an agreement and a pledge of votes on either side.