Republicans vowed to replace ObamaCare. With premiums rising, insurance providers wavering, and leading Democrats laying the groundwork for the federal government to become the sole provider of healthcare, some GOP senators are taking one final, high-stakes shot at repealing the Affordable Care Act.

What’s in the latest proposal?

Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana) have a plan (read a detailed summary here).

This bill would:

  • Give federal money to states to set up their own healthcare systems, rather than being bound by ObamaCare
  • End the individual insurance mandate
  • Scale back Medicaid expansion

Why is it now or never?

Between now and Sept. 30, Republicans can pass a healthcare bill through the Senate with only 51 votes through budget reconciliation. After that, due to a procedural ruling, it would take 60 votes.

Why is that important? Because Republicans obviously aren’t getting 60 votes since Democrats universally oppose a repeal of Obamacare. But they could at least feasibly get to 50, which would allow Vice President Mike Pence to cast a tie-breaking vote in favor of the measure.

Congress is only in session three days this week, so this will likely come down to the final week of the month, which is open only because the government funding bill was passed earlier than normal. GOP leadership prefers to use the extra time on tax reform, but some Republican senators aren’t willing to let Obamacare repeal go.

Cassidy estimates that they have 49 votes in favor of the bill. A

What happens if these Republican senators fail?

Democrats don’t have much power in government these days, but that hasn’t stopped them from coming up with grand plans for the future.

As detailed in this piece by Leon Wolf, the leading candidates for the 2020 Democratic presidential nomination are stepping over one another to get further left on healthcare, coming out in support of a single-payer system.

Vermont Senator Bernie Sanders dropped his “Medicare for All” plan on the world last week, proposing a plan for the federal government to become the only healthcare provider over the course of a four-year transition period (although he neglected to detail how that plan would be paid for).

Sanders’ plan has 16 co-sponsors, some of whom will likely be together on a primary debate stage in a few years, such as Senators Kamala Harris (California), Elizabeth Warren (Massachusetts), Cory Booker (New Jersey) and Kirsten Gillibrand (New York).

Regardless of the chances of this specific plan becoming a reality, to set the bar so far left signals that if Republicans can’t get something done on healthcare, the momentum that began in 2009 with Obamacare could snowball into an even more liberal, big-government healthcare system in America in the coming years.