Rep. Greg Walden of Oregon, who helped shepherd the party’s health-care overhaul bill through the House last month, sat down with Louise Radnofsky, The Wall Street Journal’s White House reporter, to offer his take on where the repeal and replace effort stands.

“The House has passed the American Health Care Act to try to do reforms, to get cost control on the Medicaid system, give states more flexibility to design plans that will work for them and move people into an insurance product they can afford. We know there’s more work to be done. We believe we gave the Senate some nice headroom and some dollars set aside in there to make other changes. So they’ve got some flexibility. We’ll see where this leads. But I think we’ll get a bill to the president’s desk before August.”

The chief obstacle to repealing and replacing Obamacare may no longer be congressional Democrats. It could be the GOP itself.

Senate Majority Leader Mitch McConnell has promised to hold a vote on the party’s repeal-and-replace plan by the end of June. But as he’s tacked his plan to the center as part of a bid to hold onto moderate Republicans, he’s raised the ire of conservatives who are pressing for a plan that more fully repeals Obamacare.

Senate Republicans must iron out their differences — and not let fear of the unknown derail their seven-year-long plan to repeal Obamacare. The law is collapsing. The GOP may not have made this mess, but the American people are counting on them to clean it up.

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Senate Democrats are escalating their attack on Republicans’ plans to repeal Obamacare this week, though their party remains divided on how far to take activists’ demands that they shut down the Senate in protest of the GOP’s dismantling of the Affordable Care Act.

Democratic senators are planning to hold the Senate floor until at least midnight on Monday to thrash Senate Republicans for refusing to hold committee hearings on their healthcare overhaul, according to several people familiar with the plan. The round of speeches is being organized by Sens. Patty Murray of Washington state and Brian Schatz of Hawaii.

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Conservatives inside and outside the Senate GOP are sounding alarms over the emerging shape of the chamber’s bill to dismantle the Affordable Care Act, a sign that the faction’s support may be increasingly difficult to secure.

Pressure from outside groups has intensified in recent days, and conservative lawmakers have signaled their concern that the Senate bill doesn’t do enough to curb spending on the Medicaid federal-state program for the poor or to reduce health-care premiums—two of their top goals.

“We’re not there yet,” Sen. Ted Cruz (R., Texas), a leading Senate conservative, said Thursday.

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Section 1332 of the ACA permits states to submit simultaneous and combined “superwaivers” for Medicaid and for provisions of the ACA itself. These superwaivers could make it easier for states proposing plausible ways to allow states that serve Medicaid beneficiaries more efficiently to reprogram federal and state savings into health programs for non-Medicaid eligible households. For households with working, nondisabled adults, it should also be made easier for states to pool their federal and state funds for Medicaid, the Children’s Health Insurance Program (CHIP), the ACA, and other programs to deliver coverage through private plans in the ACA exchanges. It is also time to allow states more flexibility in using Medicaid and other health care funds to invest in the social determinants of health—items such as adequate housing, school-based social services, improved lifestyles, and safer household environments, which can contribute to improved health and reduced medical costs.

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To estimate the impact of the AHCA, the CBO had to compare it to predictions of coverage under the current law, the ACA. If the prediction for the current law is incorrect the prediction of lost coverage will be too.Yet the CBO has consistently overestimated future ACA coverage gains. In 2012 it predicted an additional 28 million would gain health insurance by 2017. The actual figure is 20 million. It forecast 25 million would gain coverage on the ACA exchanges and 10 million would gain Medicaid coverage. Less than half as many actually enrolled on the exchanges and not all of them gained coverage – many were replacing non-exchange policies they lost after ACA passage. Conversely, about 14 million – 40 percent higher than predicted – newly enrolled in Medicaid. The CBO prediction that 5 million would lose employer coverage was also wrong – employer provided coverage was stable.

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The House-passed Obamacare repeal bill would leave 12.6 million more Americans uninsured over the next decade and reduce federal spending by $328 billion, according to an analysis released today by CMS’ Office of the Actuary.

The coverage estimate is well below the 23 million more uninsured that the CBO has projected under the American Health Care Act. The congressional scorekeeper additionally estimated that the American Health Care Act would reduce spending by only $119 billion over a decade.

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Senate Republicans raced Tuesday to bridge divisions over rickety insurance markets and billions of dollars in insurance subsidies in their pursuit of a health-care deal.

While President Donald Trump predicted a deal would emerge, hard work remained behind the scenes.

Much of this week’s negotiations have focused on specific measures to help shore up the individual insurance market, including billions of dollars in funding to smooth the transition to a new plan if they succeed in knocking down much of the 2010 Affordable Care Act, according to Republican aides.

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Reforming Medicaid does not have to be an all-or-nothing approach, where millions of people are thrown off of the program to reduce the budget. The states, which administer Medicaid, are closest to the problem and also are in the best position to develop solutions for Medicaid. With leeway to innovate and the pressure to achieve savings, the circumstances are ideal for change.

Since the program’s inception, the federal government has had regulations in place that mandate certain services be provided and that also set rules around eligibility. Those states seeking to innovate have had to secure a waiver from those rules.

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Senate Republicans said Tuesday that President Donald Trump was open to their suggestions about how to stabilize the Obamacare exchanges, but did not give any clear policy updates, leaving insurers hanging.

Health and Human Services Secretary Tom Price also highlighted the individual and small group markets as one of the “toughest challenges” for his employees, without providing specific steps that HHS would take. The focus on stabilizing the Affordable Care Act’s individual marketplace comes even as Senate Republicans are struggling to reach consensus on a bill that would overhaul major parts of the ACA.

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