First Read is your briefing from Meet the Press and the NBC Political Unit on the day's most important political stories and why they matter.

Trump persists in the fight for a health care win at any cost

For all of President Trump’s shortcomings in this health care debate — his lack of grasp on the policy, his unwillingness to give a major speech or hold a town hall, and his mixed messages like calling the House bill “mean” — you have to give him this: He hasn’t quit.

Despite all of the setbacks and the poor poll numbers, Trump keeps on pressing Republicans to continue their efforts to repeal and replace Obamacare, including by attacking them. “Senator @lisamurkowski of the Great State of Alaska really let the Republicans, and our country, down yesterday. Too bad!” the president tweeted this morning.

Now it’s entirely possible that these tactics come back to hurt Trump. (What happens the next time Trump needs something from Murkowski?) And you can make a legitimate argument that the last thing Republicans, including Trump, want to do is own the entirety of the nation’s health care system. But the reason that the Senate is voting on the health care legislation — and that it didn’t die yesterday — is that Trump and Senate leaders still want a win at any cost.

Senate Republicans take one step forward — then one step backward — in effort to repeal Obamacare

“With Vice President Mike Pence casting a tie-breaking vote, Republicans moved forward on health care reform Tuesday as the Senate successfully opening debate on the issue. But just six hours later, Republicans faced their first defeat in that process, failing to pass a measure that they've been working on that would have partially repealed and replaced Obamacare,” NBC’s Leigh Ann Caldwell and Vaughn Hillyard write.

NBC’s Frank Thorp says that nine Republicans voted against this replacement legislation — Sens. Susan Collins, Lindsey Graham, Rand Paul, Bob Corker, Dean Heller, Jerry Moran, Lisa Murkowski, Tom Cotton, and Mike Lee.

Per Thorp, the Senate will vote around noon today on straight repeal.

Let our news meet your inbox. The news and stories that matters, delivered weekday mornings. This site is protected by recaptcha

The skinny on “Skinny Repeal”

But the ultimate legislation that the Senate might vote on later this week is a so-called “Skinny Repeal” bill, which would eliminate Obamacare’s individual mandate and taxes on medical-device manufacturers. NBC’s Benjy Sarlin: “By voting on a partial repeal bill, Republicans would avoid heated debates within their party over cuts to Medicaid, subsidies for private insurance, and which Obamacare regulations to change or eliminate.”

But Sarlin adds that the legislation could have significant consequences. “Scrapping the mandate could create major policy headaches, however, including millions more uninsured, a spike in premiums, and a potential exodus of insurers from the market. If these changes came to pass, they would violate Republican promises to lower premiums and increase competition.”

Also: “It’s not clear the skinny repeal proposal would become law even if it passes the Senate… More likely, leaders will use it as a vehicle to negotiate with the House and try to find a broader replacement plan both chambers can agree on.”

McCain’s mixed messages

Just days after the announcement that he has brain cancer, Sen. John McCain, R-Ariz., returned to the Senate to cast perhaps the deciding vote in the motion to begin debate on the health care legislation. But he also chastised his colleagues.

“Stop listening to the bombastic loudmouths on the radio and television and the Internet. To hell with them. They don’t want anything done for the public good. Our incapacity is their livelihood,” he said. “Let’s trust each other. Let’s return to regular order.” And he criticized the Senate health bill. “I voted for the motion to proceed to allow debate to continue and amendments to be offered. I will not vote for the bill as it is today. It’s a shell of a bill right now.”

But strikingly, just hours later, McCain VOTED FOR the revised Senate bill, which went down to defeat, 43-57. And if he truly wanted regular order, voting AGAINST the motion to proceed might very well have accomplished that; Senate Majority Leader Mitch McConnell would have had to go back to the drawing board.

(On the other hand, you could argue that supporting regular order is allowing debate on the health care bill.) Our advice: Let’s let the entire process play out and judge McCain’s speech on what happens in the end.

Trump says Sessions shouldn’t have him recused himself from Russia investigation. But why?

Asked at yesterday’s news conference why he has publicly criticized Attorney General Jeff Sessions, President Trump responded, “He should not have recused himself almost immediately after he took office. And if he was going to recuse himself, he should have told me prior to taking office, and I would have, quite simply, picked somebody else.” Trump added, “So I think that's a bad thing not for the President, but for the presidency. I think it's unfair to the presidency. And that's the way I feel.”

But here’s our question: Why does the president think Sessions should NOT have recused himself? And why is he saying this more than four months after the recusal? After all, Sessions announced — back on March 2 — that he was recusing himself because the FBI was investigating the Trump campaign and because Sessions played a role in that campaign.

“I advised the Senate Judiciary Committee that ‘[i]f a specific matter arose where I believed my impartiality might reasonably be questioned, I would consult with Department ethics officials regarding the most appropriate way to proceed,” Sessions said back then. “Having concluded those meetings today, I have decided to recuse myself from any existing or future investigations of any matters related in any way to the campaigns for president of the United States.”

The message the president is sending here is that he wants a biased and partial attorney general.

“Sessions has no plans to leave office”

Meanwhile, it seems like Sessions isn’t going anywhere. The Daily Beast: “Attorney General Jeff Sessions has no plans to leave office, as friends say he’s grown angry with President Donald Trump following a series of attacks meant to marginalize his power and, potentially, encourage his resignation. ‘Sessions is totally pissed off about it,’ said a Sessions ally familiar with his thinking. ‘It’s beyond insane. It’s cruel and it’s insane and it’s stupid.’”

Downballot special election watch

Democrats have another statehouse special election to cheer about, this time in New Hampshire. In yesterday’s special state Senate election, Manchester Ward 1 Alderman Kevin Cavanaugh, a Democrat, pulled out a win against Republican former state Sen. David Boutin. While it’s not a flip (the election was held to replace a Democrat who died in March), Boutin was considered a favorite. What’s more, it’s the first time that New Hampshire Democrats have won a special state Senate election since 1984.

More from WMUR: “The win was viewed as an upset because registration figures show 35 percent of the district’s voters are Republicans and 29 percent are Democrats, with undeclared voters the largest segment, at 36 percent. In addition, Boutin had held the seat from 2010 through 2016 and was better-known district-wide than Cavanaugh.”