Senate GOP health care bill vote: Not in a good place, but McConnell may find a path

Senators come back to Washington Monday afternoon after having a full weekend to get their heads around GOP leadership's health care bill.

Senate Majority Leader Mitch McConnell wants a vote on his health care legislation before Congress leaves for a July 4 recess at the end of this week.

Here's what to watch:

What's happening right now:

There were lots of staff-level discussions over the weekend. One key thing to remember is that what each senator wants -- or needs -- to get to yes is already fairly well-known to Senate leadership and staff (opioid money, rural hospital money, more robust cutback of Obamacare regulations, etc).

Senate math: Republicans have very little margin for error on health care

Some of these proposals have even been scored already by the Congressional Budget Office during the process, as McConnell's team has been trading draft proposals of various bill sections for weeks. The question now is what McConnell will give to various sides in his trek to 50 votes. That still remains unclear to most everyone involved.

Overall where things stand:

They aren't in a good place to say the least. Sen. Dean Heller's Friday news conference, where the Nevada Republican announced his opposition to the bill in its current form, was an unexpected bomb. Conservatives very clear-cut requests will be difficult to accept while maintaining the more centrist members of the conference. CBO coverage numbers, which are expected as early as Monday, will only add to the problems.

That said, this is Congress, and things are in a bad place or dead until they aren't.

People in McConnell's orbit acknowledge the bill is probably at 50-50 at best on whether it'll be passed, and there isn't some silver bullet proposal sitting on some shelf in his office. But they also note he knows his conference better than anyone, and on an issue his folks have campaigned on for seven years, he may find a path.

What changes could be made:

Let's be cautious here and just remember, every push or pull in one direction creates a problem on the other side of the ideological spectrum. The idea that massive, wholesale changes will be made is probably a false one, according to aides.

That said, several aides note that it was no secret a chunk of the conference had major problems with shifting the Medicaid growth rate to a slower gauge starting in 2025. That's definitely something leaders are looking at right now. But, and this underscores the difficulty here: change that from the current plans for the rate of inflation and all of a sudden, conservatives who were very pleased with that addition to the bill -- a group that already feels underserved in this process -- will think they're taking another loss and expect something in return.

Will they vote this week

If McConnell has his way, yes. As one senior GOP aide said this weekend: "This doesn't get better with time. It just doesn't. Every extra day we spend on this is 24 hours for someone to get further from yes."

On top of that, and this is actually more of a driving force than anything, McConnell doesn't think they have time to spend on health care after the July 4 recess. They have a huge agenda that's sitting out there, from the aspirational (tax reform) to the necessity (debt ceiling, spending bills, Federal Aviation Administration re-authorization, etc). Those will all take up chunks of Senate floor time.

How this week would go in a perfect McConnell world:

CBO score comes Monday evening Finalize changes to draft by Tuesday nightProcess vote on WednesdayVote-a-rama starts Thursday, with final passage sometime Friday morning

Can this be pushed until after recess:

Sure. Sen. John Cornyn, the No. 2 senator in GOP leadership, said August 1 was the drop dead date over the weekend. If the rank and file demand another week on this, it will be difficult to say no. But that's not the goal. The goal is still this week.

Not a great sign

Sen. Ron Johnson was one of the four conservative senators who signed onto the joint statement saying they were opposed to the discussion draft but open to negotiations.

Johnson had been a critic of the process for weeks, and several GOP aides told CNN that the joint statement was a way to vent. He's reliable for leaders and would eventually come around, they said. However, his New York Times op-ed published Monday make pretty clear this is more than a process issue for him.

What will be in the CBO score:

It won't be great, that's for sure -- and that's more of a problem than ever, given Heller's and Sen. Susan Collins' explicit references to how this report comes out as baselines for their eventual vote. Republicans loathe the way the CBO scores their health care proposals, but that doesn't change the impact it has on members. The score may come as soon as Monday evening, but aides say Tuesday afternoon is also possible.

RELATED: Washington awaits CBO score of Senate health care bill

One thing that would help the CBO score:

A continuous coverage provision -- something the initial draft lacked. Basically, if you're repealing the individual mandate, the incentive for people to sign up for health care is diminished, likely robbing the marketplace of the most valued participants (the young and healthy).

Senate staff had been in the process of finalizing a six-month waiting period penalty of sorts for anyone who chooses to go without insurance, then decides to sign up. That is now close to finalized, per two GOP aides. The concern was that it wouldn't been compliant with budget rules, but they believe they've found a work around.

On Heller:

Senate leaders knew of his concerns with the draft legislation, and knew of his political situation back home. They did not know he was going to hold a news conference Friday and certainly weren't aware that he planned to fundamentally take apart the bill's core components, piece by piece, seeming to back up Democratic attack lines with every new answer. It was far more dramatic than anyone was expecting.

RELATED: Here's where Republican senators stand on the health care bill

As one GOP aide said bluntly: "No way we can get him to 'yes' after that display."

Final note: Watch the process vote

Preface with: Thinking this is dead, or going to die, or has no chance is a bad idea. On the Hill, with things of this magnitude and a White House that desperately needs a win, more often than not, they find a way. Nobody has a firm grasp of what that way is yet, however, but if one exists, McConnell is a pretty good guy to figure out a way to find it.

But, if this isn't going to move forward, and McConnell's threat that he wants a vote on this whether the votes are there or not is real, watch the process vote.

In order to move onto consideration of the actual bill (and the vote-a-rama amendment process), the Senate will have to vote on a motion to proceed. The vote-a-rama is a terrible, terrible process for Republican senators -- almost every amendment put up by Democrats will be terrible politically (by design). So if this is going to fail, it makes a lot more sense to have it fail before that vote-a-rama ever starts. That would be on the motion to proceed vote.