If Republicans still want to repeal the Patient Protection and Affordable Care Act with a simple majority, they'll need to do it by the end of September. The Senate parliamentarian ruled Sept. 1 that the Senate's 2017 budget resolution, which included instructions on repealing the ACA through the budget-reconciliation process that gets around filibusters, will expire at the end of the month.

"That means that Republican senators will either have to pass a new budget to repeal health care with a simple majority or they will have to have 60 votes — a filibuster-proof majority — to make changes to Obamacare," Lauren Fox reports for CNN. "The parliamentarian's decision would also mean that Congress will have to pass a new budget if it wants to overhaul the tax code using reconciliation." The Senate returns from recess today.

A repeal of the ACA would likely hurt rural areas where many residents rely on Medicaid expansion or federally subsidized individual marketplace plans for coverage. Insurers are scheduled to finalize their 2018 rates for marketplace plans today, Paige Cunningham reports for The Washington Post. Premiums for such plans could increase 20 percent if insurers don't receive subsidies from the federal government, which President Trump has threatened to withhold.

Some prominent Republicans are joining Democrats in trying to ensure that the government pays the subsidies. "A top Senate health-care committee (Health, Education, Labor and Pensions, or HELP) is bringing in five state insurance commissioners and five governors tomorrow and Thursday for two days of bipartisan hearings aimed at stabilizing the marketplaces next year. The governors include one Democrat — Colorado Gov. John Hickenlooper — and four Republicans: Massachusetts Gov. Charlie Baker, Montana Gov. Steve Bullock, Utah Gov. Gary Herbert and Tennessee Gov. Bill Haslam," Cunningham reports.

Cunningham says Senate Republicans are unlikely to try to repeal the ACA, since "all the same obstacles they faced (most significantly, how to align moderates and conservatives on an approach to Medicaid) are still present." But she thinks Republicans may simply try to starve out the ACA instead of outright repealing it, as evidenced by the Department of Health and Human Services' decision last week to slash funding for ACA advertising and helpers.