Lazaro Gamio / Axios

Looks like the effort to repeal the Affordable Care Act may be dead again, and by "dead," I mean "until it comes back again." Unless House Republicans can turn some "no" votes into "yes" votes, they probably can't pass the bill. If that happens, any or all of these people are responsible for its latest death:

  • Rep. Fred Upton, by announcing yesterday that he can't support the bill because the latest amendment "torpedoes" the ACA's protections for people with pre-existing conditions.
  • Rep. Billy Long, for saying the same thing and reportedly resisting President Donald Trump's pleas to change his mind.
  • Jimmy Kimmel, for delivering the viral monologue about his newborn son's heart defect and turning it into an emotional plea to keep covering pre-existing conditions. Former President Barack Obama tweeted his thanks for Kimmel's story.

Why they made the difference: They undermined everything the White House and Republican leaders were trying to say about why the bill would still protect sick people, even with state waivers that would let insurers charge higher rates in some cases to people with health problems.

What Republican leaders said: House Republican leaders were starting to talk yesterday about "layers of protection" for people with pre-existing conditions, including pricing protections for people who stay insured and high-risk pools as a safety net for sick people. (But that would be in place of the Affordable Care Act, which requires insurers to cover everyone with pre-existing conditions and keeps insurers from charging them more.)

What's next: GOP leaders haven't given up, and there's still a chance that they offer moderate holdouts new concessions. Rep. Mike Coffman, who said he'd vote for the bill before the waiver portion was added but is now undecided, told Caitlin Owens that adding more risk pool money "would help ... Anything that helps with people with pre-existing conditions is positive."

The optimists: "I think the odds are still better than 80 percent that we still have a vote this week," Freedom Caucus chairman Mark Meadows said last night on Hannity.

Yes, but: As New York magazine noted after the Kimmel video went viral: "What wavering House Republican is going to decide now is the time to come out in favor of the bill?"

Truth bomb: Rep. Mark Sanford to Alexandra Jaffe of Vice News: "Full repeal was, in essence, a pipe dream from the very start."

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