Congressional leaders and the White House continue to cite tax reform as a top priority for this session but a number of other issues are complicating the legislative agenda, including advancing a health care bill, passing a budget and increasing the debt ceiling before the fall.

Republican senators are still resolving ideological differences in putting together a bill to repeal the Affordable Care Act that can win 50 votes. Senate leaders have been working on a bill behind closed doors, but have been upfront that it will be different than the bill that the House passed last month. The Senate is being more deliberative in its process than the House, running various provisions by the Congressional Budget Office to get scores on what a bill would cost.

Senate Majority Leader Mitch McConnell (R-KY) and other Senate leaders are hedging on when a bill might be ready for the floor, with a best-case scenario being sometime before the July 4th recess. “I just think it’s something we have to do before we leave for August,” Senate Majority Whip John Cornyn (R-TX) told POLITICO this week. “It’s like having a baby. It’s not here yet, but it’s coming.”

Lawmakers also have until the end of September to pass some sort of spending measure to avoid a government shutdown. Congressional leaders would like to return to “regular order” and pass 12 appropriations bills for the upcoming fiscal year that begins Oct. 1, but realistically. Republicans also want to use a fiscal year 2018 budget resolution as the legislative vehicle for tax reform. If Congress can’t pass a budget resolution, it can’t move tax reform under filibuster-proof reconciliation rules.

The Treasury Department is also expected to hit the debt ceiling sometime in the fall, perhaps sooner than expected, according to Office of Management and Budget Director Mick Mulvaney. The debt ceiling refers to the maximum amount of debt that the Treasury Department can issue in order to finance the government’s operations. The debt limit was reached in March but the Treasury Department is using “extraordinary measures” to ensure essential payments are made without adding to the debt. Previous estimates projected that action on the debt ceiling would be needed by late September or early October, but Mulvaney recently warned Congress that they should raise the debt ceiling before their August recess. The White House wants a “clean” debt ceiling increase with no spending cuts tied to raising the limit. Fiscally conservative lawmakers historically have griped about increasing the government’s borrowing capacity without a commitment to rein in future spending.