The Republican plan to repeal and replace the Affordable Care Act has been dealt a number of potentially lethal blows in recent days, but some supporters of the effort — including President Trump — continue to push their colleagues to move forward with repeal. Will a vote happen? Will it succeed? And how does the news of Sen. John McCain’s brain tumor affect the numbers?

For those who weren’t paying attention earlier this week, there were a number of important developments in this story. First, Senators Mike Lee (UT) and Jerry Moran (KS) came out in opposition to the Better Care Reconciliation Act, Majority Leader Mitch McConnell’s repeal-and-replace bill. Combined with the two other senators who had already said they would vote no on the BCRA, Lee and Moran effectively killed the legislation, since the GOP can afford no more than two “no” votes at this time.

In response, McConnell and President Trump called for moving forward with a straightforward repeal-only bill like the one that Congress passed in late 2015, only to have it vetoed by President Obama.

However, the straight repeal movement seemed doomed from the start, when three GOP senators announced they could not support the legislation because of the negative impact it would have on the people in their states. These concerns were backed up by the nonpartisan Congressional Budget Office, which projected on Wednesday that repealing the ACA would leave an additional 32 million Americans without insurance and ultimately double insurance premiums for those that hold on to their health care coverage.

Moving Forward

Despite the apparent lack of votes, McConnell is still planning for a vote to open the Senate floor to debate on the repeal-only bill, in the hope that the ability to add amendments will win over moderate party members — while also betting that some skeptical Republicans will support repeal out of concern about being labeled an Obamacare supporter (more on that below).

President Trump hosted most Senate GOP members at the White House on Wednesday, urging them to not give up on the repeal effort, and to stay working in D.C. until they reach some sort of deal.

“People should not leave town unless we have a health insurance plan, unless we give our people great health care,” said Trump. “We have to hammer this out and get it done.”

About half of the Senate Republicans held a Wednesday evening meeting in the hope of hashing out their differences, reports Politico, though participants in the conference say that no specifics were discussed and there is not yet any clear road to consensus.

What About McCain?

Arizona Senator John McCain revealed last night that he’d been diagnosed with a brain tumor during a recent surgery to remove a blood clot. Aside from the many medical concerns this raises for McCain and his loved ones, it also poses a big question for Senate Republicans.

With all in attendance, the GOP only has a 52-vote majority in the Senate. With McCain out, that drops to 51 votes, meaning Republicans can only afford to lose a single vote. Two no votes would cause the bill to fail. Some in the party are concerned that this is too narrow a margin to move forward on legislation the GOP has used as a marquee campaign promise for years.

It’s unclear when, or even if, Sen. McCain will return to work.

Political Pressure

Both the White House and conservative power brokers are dangling the threat of pulling political support — or opposing outright — GOP lawmakers who don’t fall in line with the repeal effort.

Sen. Dean Heller (NV) has been skeptical of McConnell’s legislation, and at yesterday’s White House lunch, he was directly targeted in President Trump’s remarks.

“Look, he wants to remain a senator, doesn’t he?” the president asked about Heller, who was seated next to him at the time. “And I think the people of your state, which I know very well, I think they’re gonna appreciate what you hopefully will do. Any senator who votes against starting debate is really telling America that you’re fine with Obamacare.”

The last part of that statement underlines the other possible motivation for moving forward with a vote next week, even if it falls short: Getting senators on the record about where they stand. McConnell’s hope seems to be that some on-the-bubble senators will follow the party line out of fear of being seen as possibly supporting the Democrats’ signature piece of health care legislation.

But that political sword of Damocles may not be enough of a threat for some senators, particularly those who face no immediate re-election concerns. In fact, the three senators who immediately opposed the repeal-only concept are all at least two election cycles away from having to run for office again. Both Shelley Moore Capito of West Virginia and Maine’s Susan Collins do not have to run again until 2020, while Lisa Murkowski of Alaska’s seat is not up for a vote until 2022. These three lawmakers are enough to halt the entire process.

CBO: Latest Replacement Plan Just As Bad

In addition to yesterday’s CBO score on the repeal-only plan, the Budget Office has today released a revised report [PDF] on the latest version of the Better Care Reconciliation Act [PDF], finding that while the revised bill does provide more savings to the federal deficit, it does nothing to affect the number of uninsured.

Much like the last CBO score on the Senate bill, this one projects that 15 million additional Americans will go without health care after the first year of repeal. By 2026, that would grow to 22 million more people without coverage than under current law.

That figure is identical to the estimate calculated by CBO on June 26. Since then, the GOP has added more funds in the hope of reducing that number of uninsured, but to no apparent avail.

While the CBO predicts that the average costs of insurance premiums would eventually go down over the next ten years, some people will pay significantly more than under the current law. Particularly older Americans, as the GOP plan would allow insurers to charge them rates that are up to 5 times more than what is charged to younger policy holders.

The CBO also projects significant increases to deductibles — as high as $13,000 a year for an individual. The CBO says it’s possible that these out-of-pocket costs would be so expensive that “many people with low income would not purchase any plan even if it had very low premiums.”

Our colleague Betsy Imholz, Special Projects Director for Consumers Union, contends that, between the CBO scores on this bill and on the straightforward repeal effort, “The only viable, responsible course of action now is to work collaboratively to find ways to strengthen the insurance market and protect consumers across the country.”

The version of the BCRA scored by the Budget Office does not include an amendment proposed by Sen. Ted Cruz (TX) that would allow insurance companies to offer lower-cost plans that only provide minimal coverage. While that amendment could lead to fewer total uninsured Americans, critics contend that people who purchase these plans would not have adequate coverage and would still face high medical costs for the many injuries, ailments, and procedures that wouldn’t be included.

“Allowing insurers to sell plans with substandard coverage will not only cause consumers’ out-of-pocket spending to skyrocket, but will likely split and destabilize the insurance markets even further,” argues Imholz.

(Updated to include data on latest CBO score.)