The latest version of the Senate GOP’s bill to partially repeal and replace Obamacare was pronounced dead the evening of Monday, July 17, when Utah senator Mike Lee and Kansas senator Jerry Moran announced their opposition, bringing the number of “no” votes to at least four. Where do things go from here on health care? No one knows. Here are five possibilities:

2. “Repeal-and-delay.”
3. A small bill.
4. Bipartisan bailout.
5. Nothing.

Thirty years before Republican lawmakers imperilled President Donald Trump’s hopes of uprooting Obamacare, the property mogul penned some negotiating tips in The Art of The Deal. “The worst thing you can possibly do in a deal is seem desperate to make it,” he wrote.

In a week when his party’s inability to repeal and replace his predecessor’s health programme bordered on farce, Mr Trump has appeared to be following that tip. “Let Obamacare fail, it will be a lot easier,” he said, suggesting that if there was to be no deal on an orderly overhaul of the system, it should be left to collapse on its own.

With disarray over healthcare ranking among the ignominies of the president’s first six months in office, the let-it-fail mantra injected a fresh dose of chaos and confusion and drew accusations of callousness. Next week the Senate may attempt another vote on Obamacare, also known as the Affordable Care Act, but whether it will be repeal-only, repeal-and-replace or something else remains undecided.

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If President Trump is serious about repealing ObamaCare—about delivering a better policy with more choice and lower costs—there’s a simple move he could make that wouldn’t require congressional approval. It would align the interests of lawmakers and their staffers with the interests of voters.

Congress is essentially unaffected by the high costs of the ObamaCare exchanges because of a special exemption crafted under the Obama administration. The Affordable Care Act required members of Congress and their employees to participate in the health-insurance exchanges it established. They should have lost the generous coverage they had in the Federal Employees Health Benefit Program and instead bought one of the government-mandated options offered on the ACA exchanges.

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Recriminations are already underway – at the White House, on Capitol Hill, in the news media. They are debating whose fault it is that Senate Republicans can’t pass a health care bill. Was it the fault of Mitch McConnell? Or Mike Lee?  Or the half dozen other senators who balked?

In order to successfully pass a health reform bill, Republicans must do something they so far haven’t done. They must go on TV and explain how reform of Obamacare is going to solve real problems real people face. If they can’t do that, they will never have the support of the general public. Without that, Congress will never have the courage to enact major reforms.

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Arguably the most significant data point in the entire debate about the Senate health care bill has been the CBO’s claim that in 2026, 22 million fewer people would have health insurance under the Senate bill than under Obamacare.

Democrats have seized on this number to stoke fears about the bill’s impact; moderate Republicans, intimidated by the negative headlines, have been reluctant to support the bill.

But buried within the CBO’s reports is a key fact: the vast majority of those coverage “losses” occur because the GOP bills repeal Obamacare’s individual mandate. In its July 20 estimate of the most recent version of the Senate’s Better Care Reconciliation Act, or BCRA, CBO says that in 2018, 15 million fewer Americans will have health insurance under the bill, two years before its repeal of Obamacare’s insurance subsidies takes effect.

Why? It’s “primarily because the penalty for not having insurance would be eliminated.”

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The most recent version of the Senate Republican bill to repeal and replace ObamaCare would result in 22 million additional people without insurance over the next decade, the Congressional Budget Office (CBO) reported Thursday.

The number of uninsured is essentially unchanged from the original draft of the legislation released last month.

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A Health and Human Services analysis of Sen. Ted Cruz’s proposal to let insurers sell plans that don’t comply with Obamacare regulations appears to back up the Texas Republican’s claim that the idea would lower premiums across the individual insurance market. The analysis purports that the amendment offered to the Senate’s Obamacare repeal bill would slash premiums for certain Obamacare enrollees by 2020, and save even more for consumers who opt for cheaper, no frills products. HHS also found the amendment would boost enrollment by as much as as 16.1 million people by 2024, more than the nearly 14 million topline projected under Obamacare.

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How do we fix health care? The conservative policy world has offered a number of ideas, but elected Republicans have failed to coalesce around any particular strategy. J.D. Vance argues that this is because they’re unable to accept that the government must play a role in paying to solve this problem. This is where the Republican Party hits an ideological barrier that it simply must power through before meaningful reform can happen. Yes, solving problems can be expensive, and yes, that money always comes from taxpayers. Devising a vision is impossible when we refuse to accept that the government bears some financial responsibility in solving a problem it helped create.

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Senate Republicans, scrambling to win support for their health-care bill, pushed a measure Thursday that they said could ease the impact of the bill’s Medicaid cuts on low-income people.

Advocating for the new direction is a little-known health official who is now at the center of the health-care fight: Seema Verma, head of the Centers for Medicare and Medicaid Services, which oversees the two federal medical programs.

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It is a sign of Republican desperation that some think their best hope is to repeal ObamaCare and then pray something comes together in the next two years to replace it. President Trump even seems to expect that Democrats will help. Good luck with that.

Still, the repeal-only maneuver might provoke a fresh start, perhaps with a new bill drafted by some ad hoc group of legislators. Maybe failing to pass anything now will prompt wavering Republican senators to start supporting incremental, if imperfect, progress. A defeat of repeal on a procedural motion to take up the bill could cause Congress to drop health care now but return to it later, after Republicans make progress on tax reform, infrastructure, the debt ceiling and the budget.

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