The Senate will not vote this week on the Graham-Cassidy-Heller-Johnson proposal to repeal and replace parts of the Affordable Care Act (ACA), the proposal’s sponsors and Senate Republican leaders announced Tuesday afternoon.

The Senate was challenged by an impending Sept. 30 deadline to pass the proposal with a simple majority under the reconciliation rules. After that point, any ACA repeal legislation will require 60 votes in the Senate to move forward unless a new budget resolution including repeal instructions is passed for fiscal year 2018 or 2019.

With this decision, the focus shifts to overhauling the tax code which has not been accomplished in over 30 years.  Republicans have said they intend to utilize the budget reconciliation process thereby forgoing a possible bipartisan solution to the issue. There is possibility that Republican leaders could try to tackle tax reform and health care reform at the same time as a part of the FY18 budget reconciliation. However, most insiders believe this strategy to be ill-advised given the complexity of the issues. The FY19 reconciliation may be another opportunity to address health care, although what the Senate makeup looks like at that time is unknown and would be a factor.

In addition, there is hope that the Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and Sen. Patty Murray, (D-WA) will resume their bipartisan efforts to identify legislation that would help stabilize the individual health insurance marketplace.

The most immediate priority issues at this time become private market stabilization, Medicaid DSH, 340B, Medicare rural extenders, CHIP and the upcoming open enrollment period. The open enrollment period begins on November 1 and ends on December 15, but the Trump administration has cut the open enrollment period by half, creating a critical need for all community stakeholders to reach out to consumers and encourage an accessible enrollment process.