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J. Scott Applewhite / AP

The Senate health care bill, which Majority Leader Mitch McConnell has said will be released on Thursday, will contain optional state waivers of some Affordable Care Act insurance regulations, according to two senior GOP aides. But those waivers may not end up in the final bill — because they could get stripped out for violating Senate budget rules.

Here's why: The Congressional Budget Office has to give its cost estimates for the bill before Republicans can argue their case to the Senate parliamentarian that the waivers should be allowed. (The bill has to comply with Senate budget rules, and she decides whether it does.) And there's a good chance that she'll rule that the waivers, including essential health benefits, have to come out. One of the aides described the parliamentarian as "skeptical."

The Senate has long said that altering the ACA's regulations would not comply with the rules of the process the GOP is using, but the House included the state waivers in their final bill.

So that means Republicans may only be able to make the ACA's current state waivers more flexible. It's unclear how many members know this, but conservatives — who were pushing to waive even more of the ACA regulations than the House did, or even require states to opt into the regulations rather than out — will surely be disappointed.

Which ACA regulations would be covered in the state waivers:

  • Essential health benefits, or the list of 10 services insurers must cover.
  • The medical loss ratio, or the regulation of how much premium income insurers must spend on patient claims.
  • The age rating band, or the requirement that premiums for older people be no more than three times the amount of premiums charged to younger people.
  • The actuarial value, or the requirement that plans cover a certain percentage of a person's total health care costs.

Go deeper

Updated 60 mins ago - Sports

In photos: Tokyo Olympics day 6 highlights

An underwater view of swimmers including Team USA's Caeleb Dressel (R) in the final of the Olympic Tokyo Games men's 100m freestyle on July 29. Photo: François-Xavier Marit/AFP via Getty Images

There's been plenty of Olympics drama on day six of the Tokyo Games Thursday — notably China's women's swimming team beating the U.S. and Australia in the record-setting 4x200-meter freestyle relay.

The big picture: Katie Ledecky helped the U.S. win silver, which also beat the previous world record smashed by China's team. Team USA grabbed two more swimming gold medals, when Caeleb Dressel won the men's 100m freestyle and Bobby Finke triumphed in the first men's Olympic 800m freestyle.

Updated 2 hours ago - Sports

Olympics dashboard

Team USA's Simone Biles during the women's team final on day four of the Tokyo 2020 Olympic Games at Ariake Gymnastics Centre on Tuesday in Japan. Photo: Fred Lee/Getty Images

🤸🏾‍♀️: Simone Biles reacts to "love and support" after withdrawing from all-around gymnastics and team finals, citing her mental health

🏊‍♂️: Caeleb Dressel wins gold in men's 100m freestyle —Bobby Finke wins gold in first men's Olympic 800m freestyle

📷: In photos: Tokyo Olympics day 6 highlights

🗓: The Olympic events to watch today

🎾: "This one sucks more than the others," Naomi Osaka says on upset loss

🏃‍: Female Olympians push back against double standard in uniforms

Go deeper: Full Axios coverage - Medal tracker

Updated 4 hours ago - Sports

China wins Olympic gold in women's 4x200m freestyle relay, sets world record

Junxuan Yang, Muhan Tang, Yufei Zhang and Bingjie Li of Team China react after winning the gold medal in the women's 4 x 200m freestyle relay final. Photo: Al Bello/Getty Images

China grabbed Olympic gold in the women's 4x200m freestyle relay, in a surprise record win in Tokyo Thursday.

The big picture: Katie Ledecky made up time as Team USA's final swimmer to help the U.S. take silver. Australia, which was the heavy favorite, won the bronze. All three teams finished ahead of the previous world record pace.