The Republican effort to repeal and replace Obamacare appears to be dead again. The big question is whether this death will be permanent, or whether GOP activists and President Trump will effectively force party leaders to keep pushing for repeal, as they did when the House initially abandoned its health care bill in March.

With Kansas Sen. Jerry Moran and Utah Sen. Mike Lee announcing jointly Monday night that they would not support a procedural motion to take up the Senate health insurance bill, Senate Republicans don’t have the 50 members they need to move forward. The GOP controls 52 Senate seats, and Maine’s Susan Collins and Kentucky’s Rand Paul had already signaled that they oppose taking up the bill.

After Moran and Lee’s announcement, Senate Majority Leader Mitch McConnell said in a statement that he would instead push for a full repeal of Obamacare — but one that is delayed for two years. This “repeal and delay” strategy is one that Republicans reportedly considered after the election and then rejected in favor of trying to craft their own immediate replacement. It isn’t clear why McConnell thinks the strategy makes sense this time around.

So this looks like the end of Obamacare repeal — for now. But you could make a case that this isn’t over.

The case that this really is the end

These four senators refused to even move the bill to the floor. That’s significant for at least five reasons.

First, McConnell announced over the weekend that the Senate would delay any votes on the health care legislation until Arizona Sen. John McCain returned after surgery. McCain was not expected back to the Senate immediately, so this vote was not imminent.

Lee and Moran could have held back on their opposition, waiting for McCain. That they decided instead to blast the legislation in public suggests that they basically could not wait to declare their opposition. It seems they really hate it. In his statement, Moran hinted that he wanted a total overhaul of the bill, saying “we must now start fresh with an open legislative process.” This could suggest that he wants an entirely new bill.

Second, these four refused to vote even for a motion to proceed, which is only a procedural step. If they had voted for the motion, these senators could have offered amendments and still voted against the bill if they were not comfortable with the final product. This is another sign that they really hate the bill.

Third, the ideological diversity of the opponents of the legislation suggests that Republicans have a huge problem getting to 50 votes. Collins and Moran have criticized this legislation from the left, arguing that it cuts Medicaid too deeply. Lee and Paul, by contrast, have suggested that the legislation leaves too much of Obamacare in place. Such opposition from both poles of the GOP complicate the chances of passing any bill.

Fourth, Lee, Moran and Paul come from solidly red states. In theory, they should feel political pressure to back this legislation. That all three were willing to openly oppose a priority of Republican congressional leaders (as well as the Republican president) is telling. There’s an obvious reason why they are not worried about a backlash: This legislation is deeply unpopular with the public, liberals are aggressively organized against it, much of the medical community opposes it, and GOP-leaning voters are lukewarm in support of it.

Other Republicans have expressed reservations about the Senate bill, including West Virginia’s Shelley Moore Capito, Alaska’s Lisa Murkowski and Ohio’s Rob Portman. But only Collins and Paul had said directly that they wouldn’t vote for the motion to proceed, and perhaps some GOP senators weren’t willing to be the third vote against this repeal bill. This could be why Lee and Moran, not known as allies in the Senate, jointly announced their opposition.

Fifth, Republicans would like a major accomplishment during Trump’s first two years in office. There is no guarantee that the party will control the House come 2019. So at some point, Republicans probably need to consider whether tax reform is a likelier accomplishment than repealing Obamacare — and whether that should take priority.

Moran seems to be pushing for a slower process, with hearings and writing legislation in committees. That could take months and drag into next year.

The case that this is not over

First, we’ve been through this before. When the House version of the health care bill collapsed in March, I wrote a very detailed article about how the failure potentially portended bigger problems for Trump’s presidency. That conclusion did not hold up well, and the House passed a bill on May 4.

The House had essentially two versions of its health care bill, the one that failed and the one that passed. If McConnell abandons this version, he will need to write a third bill. But this is not an unimportant issue where it make sense for party leaders to give up easily. It is the repeal of Obamacare, one of the defining issues of the Republican Party since 2010. Many of these senators campaigned on repealing Obamacare, as did Trump.

Secondly, many of the more moderate Republicans, such as Capito and Portman, didn’t emerge as opponents of the legislation in the initial days after it was unveiled. Republican leaders could still be very close to the 50 that they need.

I’m struggling to come up with a third reason why the Republican effort to repeal Obamacare will ultimately succeed. Remember, on the eve of the successful House vote in May, House members were openly saying that the Senate could fix any problems with their legislation, so that in effect gave them permission to vote for a bill that they believed had some flaws. Everyone assumes the Senate bill is the final version of this legislation — most experts expected the House to pass whatever the Senate came up with. That has made this a harder fight than in the House. And so far, it’s one where it looks like McConnell will keep coming up short.