The Republican push to craft a health care bill to replace the Affordable Care Act, also known as Obamacare, hit another stumbling block Friday.

The Senate parliamentarian is reported to have decided Republicans would need 60 votes to keep anti-abortion provisions in the bill.

Republicans have a 52-48 Senate majority. It is highly unlikely that Democrats would vote to retain provisions that would block women’s ability to receive abortions.

It is also unlikely that some Republicans would support the bill without the anti-abortion restrictions.

Medicaid savings

Senate Democrats also report the parliamentarian said 60 votes would be needed for a provision providing Medicaid savings for upstate New York counties.

Democrats say they believe the New York provision places into jeopardy bill language benefiting other states. Senate Majority Leader Mitch McConnell had placed several states into the legislation in an effort to win support from the states’ senators.

Democratic Senator Bernie Sanders tweeted “The parliamentarian’s decision today proves once again that the process Republicans have undertaken to repeal the ACA is a disaster.”

The parliamentarian’s decision today proves once again that the process Republicans have undertaken to repeal the ACA is a disaster. — Bernie Sanders (@SenSanders) July 21, 2017

Republicans say the parliamentarian views are guidance only and are subject to change.

AMA: stabilize marketplace

The Republicans also received another blow to their health care bill Friday when the American Medical Association, the nation’s largest doctors’ group, urged the senators to stop their efforts to repeal and replace the ACA and instead begin a bipartisan effort to stabilize the insurance marketplace.

An AMA statement said: “The Senate’s discussion draft fails to meet the AMA’s core principles on health system reform that include ensuring that individuals currently covered do not become uninsured and taking steps toward coverage and access for all Americans including the ability for low- and moderate-income patients to be able to secure affordable and adequate coverage.”

Republican lawmakers have called for repealing the ACA since 2010, when Democrats pushed it through Congress without a single Republican vote in favor of it.

About 20 million Americans have gained insurance under the law, and national surveys show Obamacare is more popular than Republican proposals to replace it. Republicans looking to overturn the law are faced with a new, independent assessment of what might happen if they do.

CBO: Millions would lose insurance

The Congressional Budget Office said Thursday if the ACA is repealed without a replacement, 17 million Americans would lose their health insurance next year and 32 million by 2026. Under a Senate Republican replacement proposal, the CBO said 22 million would lose their health care insurance coverage to help pay medical bills in the next decade, but the plan would save the government $420 million.

