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Giphy

It's going to be tough to satisfy all of the Republicans who have problems with the House Obamacare replacement bill — conservatives who want a faster end to Medicaid expansion, Republicans from states that want to keep their Medicaid expansion, and especially moderates who are rattled by the massive health coverage losses predicted by the Congressional Budget Office.

But don't assume that's the end of the road. Smart Republicans who were around for the passage of Obamacare, the mirror image of what Republicans are going through now, tell me there's probably still a path to President Trump's desk for something they can call repeal. Just don't assume it's going to look like this bill.

The realities:

  • Republicans can't just give up on repeal after running on it in four elections. The CBO report "certainly does have a discouraging impact, but the reality is, failure is not an option," said Chris Condeluci, a former Senate Republican aide who worked on the Affordable Care Act and a member of the Axios board of experts.
  • Some Senate Republicans are criticizing the bill now and want changes, but there's no way for the Senate GOP to come up with a strategy without knowing what the final House bill will look like — since it could be changed in the Rules Committee next week before it goes to the floor, according to a Senate GOP leadership aide.
  • Senate Majority Leader Mitch McConnell is more likely to offer moderate Republicans some changes — like modifying the tax credits to boost coverage and softening the Medicaid cuts — than to pull the plug, Condeluci said.
  • But the rules are strict on what kinds of changes would be allowed under the budget "reconciliation" procedures, and if the bill changes too much, Republicans will lose the protections that allow them to pass the bill with 51 votes.
  • A bigger problem is that Trump's allies are starting to see the current bill as "deeply flawed — and, at worst, a political trap," per the Washington Post.
  • The waiting game right now is to see whether any Republicans will declare the House bill a non-starter in the Senate.
  • Rodney Whitlock, a former Senate Republican aide, notes that when Democrats passed the Affordable Care Act, it took Joe Lieberman to kill off the "public option" — which everyone knew couldn't pass the Senate anyway. Now, with the House GOP bill, "no one wants to step forward and say, 'I'm not comfortable with these numbers and I'm not voting for it,'" said Whitlock.
  • If someone does, that probably ends the exercise of trying to pass House Speaker Paul Ryan's bill. But it opens an opportunity for a more moderate Republican, like Sen. Lamar Alexander, to work with Democrats on something closer to a "repair" bill — which Alexander says he's wanted to do all along.

The bottom line: Republicans have to press forward with the current bill and drive it as far as they can. But there could be a pretty big pivot point in the Senate — and the final version of Trumpcare could look very different from this version.

Go deeper

Ben Geman, author of Generate
5 hours ago - Energy & Environment

Key clean power provision likely won't survive in Dems' spending bill

A construction worker walks along a dirt road at the Avangrid Renewables La Joya wind farm in Encino, New Mexico, on Aug. 5, 2020. Photo: Cate Dingley/Bloomberg via Getty Images

A pillar of Democrats' plans to speed deployment of zero-carbon electricity is likely to be cut from major spending and tax legislation they are struggling to move on a party-line vote, per multiple reports and a Capitol Hill aide.

Driving the news: The New York Times, citing anonymous congressional aides and lobbyists, reports that West Virginia Sen. Joe Manchin (D) has told the White House he "strongly opposes" the Clean Electricity Performance Program.

Updated 7 hours ago - World

Fatal stabbing of British MP David Amess declared a terrorist incident

Police outside Belfairs Methodist Church in Leigh-on-Sea, England, on Oct. 15. Photo: John Keeble/Getty Images

Authorities have declared the death of David Amess a terrorist incident, hours after the Conservative Party lawmaker in the U.K. was fatally stabbed while meeting with local constituents in a church in eastern England on Friday.

The big picture: The Metropolitan Police has found "a potential motivation linked to Islamist extremism."

Biden: DOJ should prosecute those who defy Jan. 6 subpoenas

President Biden speaks with reporters at Bradley International Airport in Windsor Locks, Connecticut. Photo: Brendan Smialowski/AFP via Getty Images

President Biden said Friday that the Justice Department should prosecute those who defy subpoenas from the Jan. 6 select committee.

Why it matters: The president's remarks come one day after Donald Trump ally Steve Bannon failed to show up for a deposition before the committee.