The Senate narrowly voted in favor of a motion to proceed to debate the health care bill Tuesday, giving Republicans one chance to get something done before Congress likely goes on recess in mid-August.

The Senate will continue to participate in what’s called a “vote-a-rama.”

The vote-a-rama  process was described at length by health care expert Christopher Jacobs at The Federalist, but in short, it is a grueling, head-spinning series of speeches and votes on amendments that may or may not make it into the final bill.

Much can still change as the vote-a-rama unfolds.

But one thing is abundantly clear. Failure to undo Obamacare’s damage will likely have disastrous repercussions for the Republican Party—which ran on the issue for seven years—and will certainly continue to hurt small business employees and self-employed individuals who face rising premiums and reduced plan availability.

It’s now or never for legislators who will have to face their constituents empty-handed if nothing gets done. There is a great deal at stake.

>>> 7 Years of Promising Obamacare Repeal Leaves Republicans Just 1 Option

While the particulars of the Senate bill haven’t been formalized, there are a number of important issues that need to be tackled to fix America’s health care system.

Stem the Tide of Deterioration

Obamacare has failed to keep its backers’ promise of delivering more health care options at a lower price. Instead, there are now few options at a higher price for most Americans.

Health care providers have left Obamacare exchanges in large numbers, leaving customers with fewer options that—as a result of the individual mandate that requires Americans to get health insurance or face a penalty—they can choose from.

Incredibly, about 70 percent of American counties have only one or two insurers offering plans. This certainly makes it less likely that they will have to remain competitive to get customers’ business.

On top of that, the cost of insurance is increasing for many Americans who have seen their premiums jump dramatically since Obamacare went into effect.

The Daily Signal recently reported that “[i]n 2013, the average annual cost of a premium for an individual health care plan was $2,784. By 2017, the average annual cost for a premium for an individual health care plan on was $5,712. Thirty-nine states use”

Getting Premium Costs Under Control

Clearly, the exploding cost of premiums is one of the greatest concerns for Americans. It has been exacerbated by a receding market and perverse incentives.

A number of proposals have been suggested to alleviate this problem.

One suggestion is to allow individuals to use their health savings accounts to pay for premiums. These are tax-advantaged accounts that let individuals save for routine health expenses, yet have been limited in use in part due to restrictions placed on them by Congress.

Unfortunately, under Obamacare’s regulatory structure, premiums are likely to keep climbing.

Removing Regulations

The individual mandate has been one of the most consistently attacked elements of Obamacare. Every Obamacare repeal plan has suggested removing it. Moreover, there are numerous other regulations that need to be removed as well.

Obamacare has created a problematic system of micromanaging from the federal level.

To untangle this mess, reform would have to eliminate these regulations, and importantly, return health care decisions back to states and individuals.

This would move America toward a patient-centered, market-based system in line with the limited government values that have been a hallmark of what makes this country exceptional.

Repealing Taxes

Obamacare created a number of onerous taxes.

For instance, the law imposed taxes on health insurance, drugs, and medical devices that have direct effects on the cost of care and insurance premiums. Moreover, the 3.8 percent investment tax, which applies to dividends, capital gains, among other similar investments, has been a serious burden on economic growth.

As Heritage Foundation tax policy analyst Adam Michel wrote, “Less new investment in the U.S. means fewer people are hired, and real wages rise more slowly, if at all. Employees who are not able to work with better equipment and information will be less productive and won’t be paid a higher wage.”

Removing taxes that have placed a burden on the American people must be the huge part of eventual reform.

Reform Medicaid 

Obamacare encouraged states to rapidly expand the Medicaid program, which was initially intended to help the disabled, elderly, and low-income women and children in poverty.

Though liberals have attacked health care reform efforts as an assault on Medicaid, the program has produced poor and worsening outcomes for the people it is supposed to serve.

The program itself already performed poorly as a Heritage Foundation study noted:

Medicaid is a costly and unsustainable welfare entitlement program that delivers low-quality health care to many of its enrollees … Medicaid patients frequently receive inferior medical treatment, are assigned to less-skilled surgeons, receive poorer post-operative instructions, and often suffer worse outcomes for identical procedures than similar patients both with and without health insurance.

Now it has been enlarged to include able-bodied adults who have flooded the system in high numbers.

Adding millions of people to Medicaid has not only created a financial strain on the federal government. It has made Medicaid less capable of helping those initially intended to receive the benefits.

A reform of this system would limit Medicaid’s unsustainable growth and increase access to private insurance for Americans.