Republican senators return on Monday from a 10-day recess with immediate decisions to make on their quest to overhaul the 2010 health care law.

While Senate leaders have largely avoided putting any artificial timelines on their endeavor, the GOP is under an extreme time crunch to produce and advance their own legislation to match the House bill that narrowly passed the chamber last month.

Some members, however, are now openly doubting whether Republicans can follow through on their seven-year effort to repeal and replace President Barack Obama’s signature domestic achievement.

Senate Majority Whip John Cornyn of Texas said in an interview with a local radio station last month that work on the effort would be done in the chamber by “July at the latest.” That aligns with the view of several GOP aides who say a vote on a bill would likely occur before the August recess, regardless of whether there are enough votes to pass it.

Addressing the legislation in that time frame would allow the Senate to return from the August break and immediately tackle a number of impending deadlines. Aside from the Republicans’ ambitious legislative agenda, which includes an overhaul of the U.S. tax code, Congress must also soon turn to funding the government through fiscal 2018 and addressing the approaching debt ceiling deadline, among other funding cliffs.

Toward common ground

But coming to consensus on a measure to overhaul the health care system could now become an even harder task. Before the recess, Senate Majority Leader Mitch McConnell alluded to the difficulty Republicans are facing in mustering up the necessary votes.

“I don’t know how we get to 50 [votes] at the moment. But that’s the goal. And exactly what the composition of that [bill] is, I’m not going to speculate about because it serves no purpose,” the Kentucky Republican told Reuters in an interview last month.

Now, lawmakers return to Washington, D.C., having spent the past week in their home states where they were expected to hear from both constituents and business leaders about the effort. Sen. Bill Cassidy, for example, was grilled on health care issues at a town hall. The Louisiana Republican was one of the few senators to host one over the recess.

Those interactions are sure to play a part in how lawmakers attempt to influence the legislation. In a Friday interview, Cassidy expressed hope that the time spent outside Washington would make the negotiations easier.

“I suspect everyone has had the same experience as I this past week …speaking to constituents, stakeholders and finding out what is at stake,” he said. “I’d like to think it’s going to move us to common ground.”

But back home, some GOP lawmakers are already casting doubt on the chamber’s efforts.

“I think it’s unlikely we will get a health care deal, which means that most of my time has been spent trying to figure out solutions … and things that we can bring to the table that both aid the exchange market or transition it to something that’s life after the Affordable Care Act,” North Carolina Sen. Richard M. Burrtold a local news station, referring to the 2010 health care law by its popular title. 

Those comments echo efforts by other GOP members, like Sen. Lamar Alexander of Tennessee, who want to focus in the near term on stabilizing the current individual markets for people seeking to purchase insurance in 2018.

Cassidy, however, remains optimistic a larger overhaul is possible.

“I recognize the possibility of failure, but I think we can get it done,” he said.

Deep divisions

At the heart of the issue is a Republican conference whose membership holds drastically different views on possible changes to the U.S. health care system.

The health care working group established by McConnell that originally included just 13 members was recently broadened to allow any member to attend. But there are still several competing interests at play.

Cassidy and Sen. Susan Collins of Maine continue to advocate their own legislation to the ire of other senators, aides say.

Ohio Sen. Rob Portman is also leading a smaller working group with lawmakers from states that expanded Medicaid under the 2010 law. Their interests are likely to be starkly different than members like Sen. Patrick J. Toomey of Pennsylvania and others who would prefer to put a more strict cap on the amount of money given to states for their Medicaid programs.  

The analysis of the House bill released last month by the Congressional Budget Office did the GOP no favors. While Senate Republicans say they are writing their own bill, the House legislation will still need to be used as a basis for whatever measure the chamber chooses to advance, several aides said. That presents the challenge of reworking a bill that moderates have decried as going too far and conservatives in the chamber would like to see moved more in their direction in terms of policy.  

Republicans must also grapple with the restrictions put on the process by the fast track budget procedure, known as reconciliation, that they are using to advance the bill. Conversations have begun with the Senate parliamentarian over the House legislation, which must comply with both the parameters governing the current process passed by Congress earlier this year and a set of chamber rules mandating that all measures in the bill must have an impact on the federal deficit.

That process — which involves a series of private meetings with the parliamentarian — could take months, further complicating the timeline for Republicans and ratcheting up the pressure on them to have legislation ready.  

Still, the 10-day recess likely served to bolster a point that Republican members are already well-aware of: People are concerned about the GOP’s efforts to repeal and replace the health care law.

During a recent Senate GOP conference lunch, Kansas Sen. Jerry Moran stood up and told his colleagues that constituents at his church came up to him in tears over loved ones with pre-existing conditions, expressing concern that they might not have continued health care coverage under the Republican plan.

“I think Jerry Moran’s observation/wisdom was reinforced as I was home this past week,” Cassidy said. “Other issues are abstract. Health care is not abstract.”