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Senate Republican leaders are trotting out their new, but reeling, health care bill and angling toward a showdown vote next week amid signs that they have lots of work ahead to win over GOP lawmakers or face a resounding failure. (Fram, 7/13)

The likely defection of two Senate Republicans has left their leaders no margin for error as they move on Thursday to unveil another version of their bill to repeal much of the Affordable Care Act — without an assurance that they have the votes even to begin debate next week. Senator Rand Paul of Kentucky flatly declared on Wednesday that he would not vote to take up the bill, which he said left too much of President Barack Obama’s health law in place. Senator Susan Collins of Maine has gone almost as far, saying that the bill cuts too much and that only major revisions could win her over. (Pear and Kaplan, 7/12)

Sen. Ted Cruz (R-Texas), who has demanded that the bill further loosen requirements on health plans, remained optimistic of passage, even though he indicated he would not support opening the debate unless his proposed revision was included in the new text. “I believe we can get to yes and we can bring together 50 senators behind Obamcare repeal,” Cruz said. (Mascaro and Levey, 7/12)

The revised bill is expected to include $45 billion more to combat the opioid epidemic, allow people to use funds from their health-savings accounts to pay insurance premiums, and retain the ACA’s two taxes on high-income households. Mr. McConnell responded Wednesday by warning Republicans about the perils of not coming together to pass a bill. “If we sit on our hands, families will continue to suffer,” he said on the Senate floor. (Armour, Peterson and Radnofsky, 7/12)

In a closed-door meeting of Senate Republican chairmen Wednesday, Lisa Murkowski ripped GOP leaders’ attempt to scale back Medicaid spending in their Obamacare repeal bill. The two matters were unrelated, she argued, because the Affordable Care Act did not change Medicaid spending levels across the entire program. The independent-minded Alaska senator was backed up by Sen. John Hoeven of North Dakota, a Republican generally aligned with leadership, according to senators and people familiar with the conversations. (Everett and Pradhan, 7/12)

Many Republican senators, from all wings of the party, are taking issue with the Senate GOP bill to replace most of the Affordable Care Act. The 12 below have been most outspoken, and each is flanked by like-minded senators behind the scenes. (McGill, Radnofsky and Zitner, 7/12)

Sen. Rand Paul (R-Ky.) in a new op-ed blasts the Senate GOP's healthcare bill, saying it doesn't repeal ObamaCare. In the piece published Wednesday on Breitbart News, Paul criticized ObamaCare and targeted those in the GOP who he said are not upholding their commitment to repeal the former president's signature healthcare legislation. (Savransky, 7/12)

Senate Republicans are desperately trying to craft health care legislation that can win 50 votes, and to do that they badly need skeptics like Jerry Moran. But the Kansas senator skipped a high-level GOP caucus this week, and there’s little evidence he’s about to change his mind. (Wise, 7/12)

“I want to see how funds are used to help ensure that people can get access to affordable coverage, and that’s the key,” said Senator Rob Portman of Ohio, who objected to McConnell’s original bill. “But we don’t have the specifics." (Litvan and Dennis, 7/13)

The Congressional Budget Office is analyzing versions of the revised bill that include and don’t include Cruz’s proposal. That analysis is still expected to be released early next week. “People who are really making a lot of the comments are fully invested in their point of view. There is an effort to get to compromise,” said Sen. David Perdue, R-Ga. “We really are down to one or two issues.” (McIntire, 7/12)

The White House on Wednesday released its own internal analysis of the Senate’s ObamaCare repeal and replace bill in an attempt to push back against the Congressional Budget Office’s (CBO) findings. In a statement, the White House said the CBO estimates about the Better Care Reconciliation Act’s (BCRA) Medicaid impact “should be discounted because of the large errors made by the agency in estimating the toll of the Affordable Care Act (ACA).” (Weixel, 7/12)

Senate Majority Leader Mitch McConnell (R-Ky.) is warning his colleagues to not block the chamber from taking up a bill to repeal and replace ObamaCare as leadership struggles to shore up support for the legislation. "I'm sure members will have other good ideas ... and I hope they will offer them. ... But if the Senate is prevented from even proceeding to the bill, none of us will have an opportunity — not Republicans, not Democrats, not anyone," McConnell said from the Senate floor Wednesday. (Carney, 7/12)

After hearing arguments weeks ago from Democratic and Republican aides, Parliamentarian Elizabeth MacDonough issued her opinion that the House bill (HR 1628) complies with jurisdictional requirements within Senate reconciliation instructions. The development is significant because it means the hotly debated health care repeal written by the House can move more smoothly through the Senate without procedural problems. There still may be other challenges under the Senate's Byrd rule, which bars extraneous matter, once the bill is under debate. (Krawzak, 7/12)

Just four days after Senate GOP leaders revealed their health-care bill this summer, Tucson Medical Center hosted a town hall thousands of miles away drawing roughly 700 people in person and 1,900 online. In its aftermath, hospital employees, doctors and members of the public sent nearly 2,900 emails to the state’s two senators, Republicans John ­McCain and Jeff Flake, urging them to reject any legislation that would jeopardize patient health care. The move was like nothing the hospital had done before, said Julia Strange, the center’s vice president for community benefit. (Eilperin and Cunningham, 7/12)