The Republican healthcare bill: what's next in challenge to Obamacare?

Republicans rushed an updated version of their healthcare plan through the House of Representatives earlier this month without knowing how much it would cost or how many people would lose insurance as a result. This week, the nonpartisan congressional budget office released its assessment – and the accounting was bleak.

The agency forecast that 23 million people would lose insurance over the next decade, people with pre-existing conditions could face substantial increases in out-of-pocket spending on health care and maternity coverage could cost women an extra $1,000 per month.

Now that lawmakers have seen the “score”, the fate of the US healthcare system shifts to the Senate, where a group of Republicans are hammering away at their own version of the plan. Here’s a look at the next steps.

Is this bill going to pass?

The House bill stands virtually no chance of passing the Senate in its current form. The Senate has repeatedly pledged that it would substantially change it.

“The House made a stab at it but that’s not going to be what the Senate votes on, at least initially,” John Cornyn, the second-highest ranking Republican in the senate, said on Thursday. “We’re going to try to build consensus.”

But they’re certainly not there yet. The working group charged with shaping the Senate’s health care plan has yet to find the common ground to even begin drafting new language. The Republican Senate majority leader, Mitch McConnell, told Reuters on Wednesday: “I don’t know how we get to 50 [votes] at the moment. But that’s the goal.”

Fifty votes are needed for it to pass in the 100-member Senate because in the event of a tie vice-president Mike Pence would have the casting vote.

Why does the CBO score matter?

The CBO score will help set the parameters around the healthcare debate in the Senate, where Republicans are sharply divided over how to reshape the House bill.

After weeks of working group meetings, Senate Republicans are expected to put pen to paper and begin drafting the healthcare bill over the upcoming 10-day recess, guided in part by the findings in the CBO score.

It’s also important because Republicans are using a process known as budget reconciliation in order to avoid a Democratic filibuster. As such, the health care plan must comply with a series of special rules, including one that says the bill must not increase the federal deficit in a 10-year window. The score found that it would reduce the deficit by $119bn over the next decade.

How did Republicans react?

They sent mixed signals. The White House dismissed the report, saying the agency was “totally incapable of accurately predicting how healthcare legislation will impact health insurance coverage”. But the House speaker, Paul Ryan, embraced the findings, saying he was “comforted” that the report showed the plan would lower premiums.

A number of Senate Republicans immediately distanced themselves from the House plan after the score as released.

“Congress’s focus must be to lower premiums with coverage which passes the Jimmy Kimmel test,” said Louisiana Senator Bill Cassidy, referring to the comedian’s plea after a health scare involving his newborn son that lawmakers keep the Obamacare rule preventing insurers from discriminating against people with pre-existing conditions. “The ACHA does not. I am working with Senate colleagues to do so.”

How long will the bill take?

Senators have been reluctant to commit to a timetable but caution that the bill could take weeks to finalize.

Cornyn told reporters that he thought the Senate would hold a vote on its version of health care overhaul “sometime before the August recess”.

If Democrats pass a different bill, the legislation will then go to a conference committee. There lawmakers from both chambers would hammer out the differences between the two versions of the bill. When a consensus was reached, the plan would be presented to both chambers for a final vote.