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Republicans remain unsure how their health care effort ends
Carolyn Kaster / AP

Both the Senate's Affordable Care Act replacement plan and its partial repeal bill have now failed by significant margins, leaving their best chance at passing anything a "skinny" repeal bill, which some members openly say is just a vehicle to a conference committee with the House. But it's hard to see where all of this ends.

The bottom line: The Senate seems to have proven definitively that Republicans can't agree on an ACA replacement plan. It's very hard to see any reason why that would change in conference. So that leaves the option of the House passing the Senate's skinny repeal plan — which sources aren't ruling out — which has major policy flaws and could cause premium increases right before next year's elections.

Yet no Senate Republicans have come out against the skinny repeal plan yet. "This is like a car crash. Everyone will slow down to look at the carnage but no one will get out to help," said one senior GOP aide.