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AP file photo

Four Senate Republicans — Ted Cruz, Mike Lee, Rand Paul, and Ron Johnson — just released a statement saying they're "not ready to vote for" the Senate health care bill. That's enough to kill the bill if they actually vote against it. "It does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs," they wrote.

The bottom line: If a rebellion happens, it's largely because conservatives want to get rid of more of the Affordable Care Act's insurance regulations. And that's a big part of the Republican dilemma. Conservative Republicans say those rules make individual health insurance more expensive, and they're right — but the most expensive regulations are the ones that protect people with pre-existing conditions, which is exactly what Senate Republicans don't want to get rid of.

Deeper dive: The draft Senate bill would let states escape some of the ACA's "Title I" insurance regulations, like minimum benefit requirements — but not the pre-existing condition protections, like requiring insurers to cover sick people and preventing them from charging those consumers higher rates. According to an analysis circulated by Sen. Bill Cassidy, prepared by the consulting firm Oliver Wyman, that's what added the most to individual insurance costs.

Here's what Cruz said earlier this week: "There is no doubt there has got to be significant reform to reduce the burdens from the Title I insurance mandates. Why? Because they're one of the principal drivers of premiums skyrocketing."

For context: Sen. Rand Paul said today that it's more than just the regulations — it's also the fact that the Senate bill keeps the ACA subsidies in a scaled-back form: "It doesn't fix the death spiral in Obamacare, it simply subsidizes it with taxpayer money to insurance companies."

What the House bill does: It allows states to waive the pricing rules for sick people under certain conditions. The Senate bill doesn't go that far.

Go deeper

Biden says he raised human rights issues in Putin summit

President Biden with Russian President Vladimir Putin in Geneva, Switzerland, on June 16. Photo: Mikhail Metzel\TASS via Getty Images

President Biden said he raised issues including nuclear arms control, cybersecurity, election interference and violations of human rights in Russia in his meeting with Vladimir Putin in Geneva on Wednesday.

What he's saying: "My agenda is not against Russia or anybody else. It's for the American people," Biden said at a press conference following the summit, which was shorter than expected.

Southwest heat wave intensifies, breaks records and worsens drought

A temperature "misery index" shows peak levels across the Southwest (orange and yellow), and the upper air flow shows how the jet stream is being pushed north, away from the heat dome parked over the Four Corners region. (Earth.nullschool.net)

A punishing and long-enduring heat wave is intensifying in parts of the West and Southwest, with heat warnings and advisories in effect across seven states Wednesday. The heat will not relent until late in the weekend.

Threat level: In the coming days, 40 million are likely to see temperatures reach or exceed 100 degrees.

Updated 1 hour ago - World

Putin calls Biden summit "constructive," but blames U.S. for tensions

Photo: Sergei Bobylev\TASS via Getty Images

Russian President Vladimir Putin said Wednesday that his summit with President Biden was "constructive," and that the countries had agreed their ambassadors would imminently return to their posts in Moscow and Washington.

What he's saying: "Many of our joint positions are divergent but nevertheless I think both sides manifested a determination to try and understand each other and try and converge our positions," Putin told reporters at a press conference following the meetings, according to a translator.