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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

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 54 mins 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.

Updated 1 hour ago - World

Live updates: Putin concludes press conference, Biden up next

President Biden met with Russian President Vladimir Putin in Geneva for less than four hours of talks on Wednesday, a highly anticipated summit that comes as both sides say U.S.-Russia relations have sunk to a new post-Cold War low.

The latest: At a press conference following the conclusion of the summit, Putin called the talks "very constructive' and announced that the U.S. and Russia's respective ambassadors would return to their posts.