Senate Majority Leader Mitch McConnell, R-Ky., on Aug. 21 gave no assurances his chamber would be able to get a healthcare reform bill passed when lawmakers return to Capitol Hill in early September, declaring the path forward was "somewhat murky."

"Obviously we had a setback on the effort to make dramatic changes on Obamacare," McConnell said during a chamber of commerce event in Louisville, Ky., acknowledging that Republicans in the Senate failed before their August recess to pass legislation to repeal and replace the Affordable Care Act.

Republicans hold 52 seats in the Senate, but McConnell fell short in getting enough members of his party on board to pass a healthcare bill using a 51-vote simple majority. He failed in July on three separate attempts: a comprehensive repeal and replace bill, the Better Care Reconciliation Act; the repeal-only legislation, the Obamacare Repeal Reconciliation Act; and the "skinny repeal" bill, the Health Care Freedom Act, which would have ended the ACA's requirements for eligible Americans to buy healthcare insurance or pay a tax penalty and put other temporary provisions in place.

But the Senate chief admitted lawmakers must do something to prevent insurance markets from further collapsing, although he said simply subsidizing them was "pretty controversial."

Stabilizing the market

For now, McConnell said the Senate's next steps for healthcare reform are in the hands of Sen. Lamar Alexander, R-Tenn., chairman of the Health, Education, Labor and Pensions Committee, who is tasked with working out a deal with Democrats, led by Sen. Patty Murray, D-Wash., ranking member of the panel, to stabilize the individual insurance market.

Part of Alexander's plan involves taking the cost-sharing reduction payments out of the hands of the Trump administration and putting the appropriations of those funds with Congress for at least the next year.

The payments help cover deductibles and copayments for about 7 million low-income Americans enrolled in ACA plans offered by private insurers through the government-run marketplace.

But President Donald Trump has threatened to withhold the payments — using them as leverage to get Congress to pass an ACA repeal bill.

The Trump administration has been making the cost-sharing reduction payments to insurers on a month-by-month basis, with no guarantees beyond August.

But that situation has created uncertainty in the insurance market, which is expected to drive premium rates up for 2018, according to a recent analysis by the Kaiser Family Foundation.

If Trump terminates the payments, healthcare insurance premiums would leap 20% in 2018 for many Americans who get their coverage through the ACA, and the U.S. deficit would also rise by $194 billion over the next decade, the nonpartisan Congressional Budget Office recently reported.

"When we get back after Labor Day we'll have to sit down and talk to [the Democrats] and see what the way forward might be," McConnell said.

House chief to Senate: Get back to work

Meanwhile, House Speaker Paul Ryan, R-Wis., rubbed salt into the Senate's wound.

"Who wasn't disappointed that the Senate failed to pass that bill by one vote," Ryan said during a town hall event in Racine, Wis., hosted by CNN. "In the House, we did pass it," he said, noting that his chamber adopted its ACA repeal-and-replace bill in May, although by a slim margin of 217-213.

The status quo "is not an option," he said.

"The Senate has to get back and keep at it," he said. "What I've been telling our friends in the Senate, get back to work, get a bill passed. We will meet you in conference to figure this out, but we can't take no for an answer. And unfortunately, that's kind of where we are with the Senate right now."

"The House has done its job," Ryan added.