The chances that Congress will continue trying to repeal or replace the Affordable Care Act (ACA) have significantly reduced, as the Senate is determined to instead proceed with a tax cut or tax reform.

President Trump continues to press Congress for repeal or replace, and is suggesting he may discontinue cost sharing reduction payments to insurers which subsidize low income enrollees in the healthcare exchanges. Senate and House Republican and Democratic support is strong to continue those payments to avoid disrupting that coverage.

On August 7, 2017, Senate Marjory Leader McConnell reportedly stated that he is open to legislation mandating the payments if tied to ACA reform. Some Senate and House Democrats support reform, such as repeal of the medical device tax and broader flexibility for states implementing the ACA. Other Democratic Members of Congress will advocate for the payments without any changes that might weaken the ACA. This is shaping up as the next major Congressional debate on the ACA's future.