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Rand Paul speaks in Kentucky. Photo: Bryan Woolston / AP

Rand Paul, who has become a do-or-die vote for the Republicans' last-ditch effort to repeal and replace the Affordable Care Act, is sending a list to the White House of what it would take to get him from no to yes.

We've obtained the list and, if the White House and Senate Majority Leader Mitch McConnell accept Paul's demands, it's hard to see how they'd stop at least half a dozen moderate Republican senators dropping their support for the Graham-Cassidy health care bill.

Why this matters: This could definitively kill Graham-Cassidy. President Trump, who has a warm personal relationship with Paul, hasn't given up winning his support for the bill, even though the Kentucky senator has relentlessly and publicly attacked the legislation. Trump continues to personally lobby Paul and administration officials believe they've got a better chance of flipping him than they do to convince the moderate Sen. Susan Collins to vote for the bill.

Here's what Paul is asking the White House to do:

  1. Cut the Affordable Care Act spending way back. He says that "only a significant reassessment of this trillion-dollar spending regime would get my support." The problem with this demand is that if you have deep cuts in health care spending you will push away other moderate Republicans, and not just Collins and Alaska's Lisa Murkowski.
  2. Scrap way more Affordable Care Act regulations. He says that states should "have to opt into ACA regulations," rather than having to opt out. The problem with this demand is that it only appeals to conservatives. You'd get Ted Cruz on board but still lose other moderate Republicans.
  3. Expand association health plans, which would let small businesses and individuals band together to buy health insurance. The problem with this demand is that Republican leaders have already determined they can't do this through the budget reconciliation rules.

Bottom line: Republicans have already lost John McCain; they can only afford to lose one more senator. Nobody I've spoken to thinks Collins is gettable. Therefore Paul and Murkowski become the decisive votes. Paul's list of demands suggest he's not an absolute no, but his conditions may be impossible to meet.

Go deeper

Mike Allen, author of AM
8 mins ago - Politics & Policy

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Photo: "Axios on HBO"

Sen. Bill Cassidy (R-La.), a physician, told me during an "Axios on HBO" interview that he favors cognition tests for aging leaders of all three branches of government.

Why it matters: Wisdom comes with age. But science also shows that we lose something. And much of the world is now run by old people — including President Biden, 78.

Ina Fried, author of Login
18 mins ago - Technology

Intel CEO blames predecessors for manufacturing woes

Axios on HBO

When it comes to Intel's recent manufacturing problems, Intel CEO Pat Gelsinger places the blame squarely on his predecessors — many of whom he notes were not engineers deeply steeped in chip technology, as he is.

Why it matters: Gelsinger has announced a broad plan to reinvigorate Intel by doubling down on manufacturing. However, the strategy depends on the venerable semiconductor giant recovering from recent stumbles.

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Illustration: Rae Cook/Axios

Marketers are pouring money into figuring out the tastes and habits of Generation Alpha — kids born from 2010 through 2024 — who are unprecedented in the extent they're growing up online.

Why it matters: They're weaned on TikTok, Amazon and in-app purchases. They're learning from their millennial parents to hold brands accountable for causes like social justice and sustainability. And no prior age cohort will be as large in size or marketing power.