Is the Republican effort to repeal and replace Obamacare really dead? All you need to know

Donald Trump predicts a vote on healthcare will happen during the first three months of next year.

Republican Senator Lindsey Graham flanked by Senate Majority Leader Mitch McConnell (AP)

Senate Republicans this week were forced to announce the death of their latest push to repeal and replace the Affordable Care Act, otherwise known as Obamacare.

But Senate Majority Leader Mitch McConnell has said Republicans have not given up trying to change America's healthcare system.

Is the Republicans' effort to repeal and replace Obamacare really dead?

No. But but it’s going to be significantly harder for them to repeal and replace the healthcare law after September 30. That date is when Congress’s current “budget reconciliation” instructions expire.

Mr McConnell had attempted to pass a healthcare bill under the budget reconciliation process. To conform to the rules of reconciliation legislation – meaning the Senate only needs 51 votes to push forward a measure – the bill must meet certain requirements, including reducing the budget deficit.

What happens after the September 30 deadline?

Any healthcare bill could be filibustered – when debate over a proposed piece of legislation is extended – and would need 60 votes to end the filibuster, or invoke closure.

Requiring 60 votes to end debate is a unique characteristic of the Senate and has the effect of requiring some Republicans to work with Democrats to push forward legislation.

This means that to pass any healthcare legislation by the end of the year after September 30, Mr McConnell will need at least some Democratic support.

Could the Senate get 60 votes?

It is highly unlikely that 60 senators will vote in favour of an Obamacare repeal bill. Republicans only hold a 52-member majority in the 100-member Senate, and Democrats have been united in opposition against every iteration of Obamacare repeal this year.

For this reason, President Donald Trump has repeatedly called on the Senate’s leadership to “Get rid of Filibuster Rule!”

Could Republicans go back to only needing 50 votes?

If Republicans want to set up reconciliation again, they can – by passing a new budget resolution with new “reconciliation instructions.”

In January 2017, congressional Republicans passed a budget resolution for fiscal year 2017, which set up the reconciliation process for Obamacare repeal.

Reconciliation instructions expire at the end of Congress’s fiscal year – September 30.

How could midterms change everything?

There is a tenuous balance of power in the Senate.

Republican Senator John McCain of Arizona, who helped kill multiple attempts by his party to pass an Obamacare repeal bill, is currently receiving treatment for or an aggressive type of brain cancer. Should his seat become vacant, the governor of Arizona may appoint someone more likely to vote for legislation that would overhaul the ACA.

It will also be a challenge for Democrats to take back the Senate in 2018. While they only need a net gain of three seats in the 100-member Senate, they are also defending 25 seats – 10 of which are in states that Mr Trump won.

But Republicans look like they are beginning to wage war against each other in Senate primaries – the establishment v populist candidates backed by Steve Bannon, a Breitbart executive and former top aide to Mr Trump. This means that financial resources the party would normally use to attack Democratic candidates in the general election are being utilised to defend Republican incumbents.

Anything could happen next year. But if Republicans have majorities in both houses of Congress, another drive to repeal and replace Obamacare is possible.