In an effort to repeal the Affordable Care Act and reform America’s health care system, Republicans in the House of Representatives sent the American Health Care Act to the Senate after narrowly passing the legislation May 4.

Senate Republicans wrote their own version of the bill, the Better Care Reconciliation Act, releasing a draft June 22.

If the Senate passes their version of the bill, the legislation will return to the House where a passing vote could send it to President Trump’s desk, or a congressional conference committee will consolidate the House and Senate bills into a single piece of legislation to be voted on again.

The fate of Republican efforts to reform the health care system rests on the success of the Senate’s bill.

1) The bill has drawn criticism for being negotiated in secret.

The Senate bill originated from a group of 13 male Republican Senators including majority leader Sen. Mitch McConnell and Sen. Ted Cruz.

Both Democrats and Republicans have both criticized the group for its lack of transparency and secrecy in crafting the bill including Sen. John McCain who vocally opposed the bill in a June 20 interview.

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Senate Republican leadership originally planned to vote on the bill June 27, but postponed the vote until after July 4.

Unlike the ACA, which received a 100 public and roundtable hearing in Senate finance and health committees, Republicans have not scheduled a single public hearing for their bill.

Congress members proposed more than 500 amendments to the ACA and debated it for 25 consecutive days in a bipartisan committee. The bill passed along party lines seven months after public discussion began in the Senate.

2) The Senate bill’s biggest difference limits states’ independence.

While the Senate opted to craft its own health care bill, it shares some aspects of the House version.

The Senate bill includes provisions that allow states to decide what must be included in every health plan, while the House bill provides states a way out of providing basic essential care. That amendment was one of the deciding factors in passing the House bill.

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Both bills eliminate funding for Planned Parenthood for one year. The ACA only prevented funding from being used to offset the costs of an abortion.

Both bills eliminate two taxes on the wealthy levied by the ACA.

Neither bill requires large employers to provide employees with affordable health care, but keeps the provision allowing children to remain on their parents’ health plans until age 26.

3) The CBO predicts less coverage, but lower rates.

The Congressional Budget Office, a non-partisan agency which provides forecasts of bills’ effects to Congress, released their first report on the Senate bill June 26.

According to the report, 22 million people would lose health care by the year 2026. Over that time, the bill would reduce federal spending on health care by $321 billion.

The CBO predicted 15 million people would lose health care in 2018, but by 2026, health care premiums would be 20 percent lower. The decrease in price would result from higher premiums and deductibles alongside lower coverage.

Cuts to Medicaid would reach $772 billion by 2026 as the bill caps the program’s growth and increase states’ financial role. The Senate bill makes deeper cuts to Medicare as well.

Finally, the CBO said the repeal of ACA taxes cut taxes for corporations and wealthy individuals by $563 billion over 10 years.

4) Arizona will be hit by Medicaid reductions.

Arizona receives about 75 percent of Medicaid funding from the federal government, the seventh highest percentage in the nation. 

Due to this, the state is more likely to feel federal cuts.

Medicaid covers 20 percent of Americans, 49 percent of childbirths, 64 percent of nursing home patients, 60 percent of children with disabilities and 39 percent of children.

The bill does not exempt health care providers from covering pre-existing conditions, but does allow states to waive certain essential health benefits.

The Senate bill has a softer blow to low-income households by determining subsidies based on income and coverage costs in local communities, as opposed to the House bill, which provides individuals subsidies based on age.

5) The bill has experienced widespread opposition.

An NPR, PBS NewsHour and Marist Poll found 17 percent of Americans support the Senate Health Care bill and 55 percent oppose it.

Currently, no Democratic senators support the bill, and eight Republican senators have publicly stated they do not support the bill in its current form.

McConnell postponed voting only after determining the bill wouldn’t pass.

Even the Koch brothers came out against the health care bill, eliminating Republican hopes for a campaign to sway public opinion.

Over half a dozen Republican governors, including Ohio Governor John Kasich, and many Democratic governors publicly and definitively opposed the Senate health care bill.

AARP (American Association of Retired Persons) and many other health care associations and providers have publicly denounced the Senate bill and have called for Congress to start from scratch.

With all the speculation surrounding bill, the fate of Republican efforts to repeal the ACA remains uncertain.

Follow Randall Eck on Twitter.