Now that Senate Republican leadership has decided against voting on the Graham-Cassidy healthcare bill, the most recent Republican proposal to repeal and replace the Affordable Care Act (ACA), the party is regrouping on next steps, so don’t count repeal and replace dead and gone just yet.

Many Republicans fundamentally believe some basic tenets of the ACA must go, such as the requirement for every individual to be insured and the costly (if effective) required basket of essential benefits for qualified plans —such as vaccinations and well checkups.

Other Republican senators are just as motivated by the politics of the issue. CNN and other news outlets reported that Senator Chuck Grassley (R-Iowa) recently told Iowa reporters “You know, I could maybe give you ten reasons why this (Graham-Cassidy) bill shouldn’t be considered, but Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Making the task harder in the future is a September 30, 2017, deadline. Until then, under a process called budget reconciliation, the Senate can pass any legislation that includes savings for the federal government with a simple majority, fifty votes plus Vice President Pence as the tiebreaker.

The sixty votes needed for most legislation would require Democrats—none of whom support repeal of the ACA, to come on board. Those same rules—fifty-one votes needed for legislation that garnered federal savings–could be written for the next bite at health care, but most senators want to use the rule for tax reform—next up on the legislative agenda– and generally the Senate only considers one issue at a time under the budget reconciliation rules. “It’s unlikely that the GOP caucus will want to use reconciliation protections — a precious resource — on another health care effort without evidence that circumstances have changed or that they have an approach that they know can pass,” says Tevi Troy, president of the American Health Policy Institute in Washington, DC and former Assistant Secretary at the Department of Health and Human Services under George W. Bush.

So, what will Republicans do next? Here are a few of the possibilities:

• Could Graham-Cassidy rise again? The authors of the Graham Cassidy bill issued a statement on September 26 after the vote on the bill was tabled in the Senate which said in part “it’s not a question of ‘if’ Graham-Cassidy-Heller-Johnson replaces Obamacare – it’s only a question of ‘when.”

But key points of Graham-Cassidy remain sticking points for Republicans including putting limits on Medicaid per person spending and leaving each state to decide whether and how it will cover pre-existing conditions. Add to that Senator Susan Collins, Republican of Maine thought the bill cut coverage for too many Americans while Senator Rand Paul (R-Kentucky) thought it left in too many subsidies. Watch this space.

• Molly Reynolds, a fellow in governance studies at the non-partisan Brookings Institution, says Senate Republicans could try to pass both tax and health care reform in this session of Congress. However, says Reynolds, “Given how much time and energy Republicans have spent thus far with nothing to show for it on health care, many may be reluctant to tie the fate of a tax bill to an issue where victory has been so difficult.
• Could the bipartisan effort come back to life? Earlier this month Republican Senator Lamar Alexander (Tennessee) and Democratic Senator Patty Murray (Washington) spearheaded hearings on bipartisan legislation to overhaul the ACA, but that effort was sent to the wings while Graham-Cassidy briefly took the stage. According to reporting by PBS, Iowan Republican Senator Jodi Ernst, even before the kibosh came for G-C, told a town hall meeting of her constituents that she’d like to see the bipartisan efforts return during this session of Congress.  

But wait out this plan year and Republican members of Congress may just find greater support for repeal and replace among voters. That’s because the Trump Administration is making it a bit harder to sign up on the health exchanges this year. The U.S. Department of Health and Human Services, which administers the ACA, has drastically cut back on funding for advertising the health plans and enrollment dates for 2018 coverage, as well as for paid navigators to help individuals sign up. HHS has also shortened the sign-up period from last year’s last day of Jan 31 to this year’s December 15th. And HHS will take down the Healthcare.gov site used for health insurance signup, for maintenance, from 12 am to 12 pm most Sundays of the sign-up period.