After three Senate Republicans said they would not vote for the latest version of the repeal-and-replace bill, the leadership decided not to hold the vote that had been planned. A number of Republicans have vowed that the battle is not over and that they will try again, although when is not at all clear.
Senator Rand Paul said he would not vote for the Graham-Cassidy bill because it leaves too much of the Affordable Care Act in place. Senator John McCain said he would not vote for the bill because he wanted to see the Senate hold hearings and act on a bipartisan basis. Senator Susan Collins said she would not vote for the bill because of the deep cuts to Medicaid and loosening of protections for people with pre-existing conditions. Given these positions, it seems unlikely that any compromise can be reached. Any changes that would get Senator Paul to vote for the bill would likely cost votes among moderates and any changes that would get Senator Collins to vote for the bill would probably cost votes among conservatives.
There appears to be renewed interest in acting on a bipartisan basis to strengthen the Exchanges, but it is also unclear that any agreement could be reached. Democrats want Congress to commit to multiple years of funding cost-sharing reduction payments to insurance companies, but Republicans seem to prefer a one-year commitment. Republicans also want Democrats to make concessions in Exchange for funding the cost-sharing reductions, but Democrats do not appear inclined to give Republicans what they want the most, which is the loosening of rules regarding people with pre-existing conditions and the definition of Essential Health Benefits.