After promising a vote on health care reform legislation before the Independence Day break, on June 27, Senate Majority Leader Mitch McConnell announced that a vote on the legislation was being postponed. In May, the House of Representatives narrowly passed a health care reform bill. Republican senators continue to negotiate in hopes of reaching an agreement.

A significant difference between the House and Senate versions concerns the use of tax credits to help individuals and families pay for health insurance. The Senate version adjusts the tax credit amount based on income and geography much like it is currently under the Affordable Care Act (ACA). In contrast, tax credits in the House version are less generous and based strictly on age.

Passage of health care reform in the Senate remains challenging given the narrow Republican advantage. Democrats are unanimous in their opposition to the proposal, which means Leader McConnell can only lose two Republicans and still pass the legislation using Vice President Mike Pence as the tie-breaking vote. Eight Republican senators have publicly expressed opposition to the bill, Shelley Moore Capito (WV), Ted Cruz (TX), Ron Johnson (WI), Mike Lee (UT), Jerry Moran (KS), Rand Paul (KY), and Rob Portman (OH).

Under normal Senate procedure 60 votes are needed to end debate, but under "budget reconciliation" only a simple majority is needed. However, for any legislative provision to be considered under budget reconciliation it must impact the federal budget and not increase the deficit after its first 10 years. For example, there are questions as to whether the Better Care Reconciliation Act can change current law by allowing states to opt-out of the essential health benefits requirement since the focus of provision is not budgetary.

The Congressional Budget Office (CBO) estimates that the initial Senate proposal would cause 22 million individuals to lose insurance coverage but save the federal government $321 billion over the first 10 years. By comparison, CBO estimates that the House-passed reform bill would result in 23 million fewer Americans being insured but save the federal government $119 billion over the first 10 years.