Health care state of play: Republicans work behind closed doors to advance Graham-Cassidy

It's all behind the scenes now.

Republican leaders are dealing. Trump administration officials are educating. And Democrats are doing their best to re-engage their outside opposition groups to give GOP senators hell back at home.

The Senate is out until next week, so we won't see the members in DC until Monday, also known as the week they are supposed to vote on the Graham-Cassidy health care bill.

It really all comes down to McCain and Murkowski:

Aides and senators are making clear what we all assumed -- it's on Sens. John McCain and Lisa Murkowski. They have to get them both. Both have a lot of concerns. But notably, both haven't shut the door yet. As I noted Tuesday, McCain is anyone's guess at this point, with his best friend and bill co-author Lindsey Graham working overtime on him.

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But on Murkowski, there is substantive work at play to bring her around. Republican leaders and administration officials are attempting to craft a proposal to put Alaska in a much better place in the bill as it relates to its funding formula for its block grant, several aides tell CNN -- it's just a question of whether that adequately addresses the concerns about the bill's impact. It's not a small thing that the state's independent governor signed a letter opposing the bill Tuesday, as Murkowski told reporters she talks to him regularly and is seeking his input. But that opposition didn't push her against the bill on its own.

Key player ahead:

Centers for Medicare and Medicaid Services Administrator Seema Verma, deployed as a secret weapon of sorts in the House effort, something she couldn't quite replicate in the Senate in July, is going to be available on speed dial for Murkowski and her staff. Senate leaders and administration officials believe she is the one who can get this done -- or at least give them their best shot.

President Donald Trump and Vice President Mike Pence have made clear to Senate leaders they are willing to hop on the phone with anyone needed, GOP aides say. It's still unclear if there will any kind of public push (though the President contributed two tweets to the effort Wednesday morning), but the administration is very engaged (and quietly had been for a few weeks, especially Pence).

Keep an eye on: Senate leaders have the door open for senators to ask for changes to the bill and that's happening -- what those changes will be (opioid money? Some additional stabilization money?) will also be important to some degree.

Wednesday's required reading from CNN's Hill team:

Ted Barrett on Mitch McConnell's tight-rope walk in the days ahead Lauren Fox and MJ Lee with the absolute truth: the real work begins now. More excellent Tami Luhby on what matters most: the policy implications: MJ on the other primary GOP holdout -- McCain's choice: legacy or repeal.

The Kimmel Test:

Does a late night comedian who clearly doesn't align ideologically with Republicans ripping the proposal and calling its co-author a blatant liar create a major problem for this bill? On its face, probably not -- Mitch McConnell isn't exactly scared of Jimmy Kimmel winning a policy battle with his members.

But here's where it does matter -- it brings heat and light to the bill, the process and what could happen as soon as next week, and in the most negative of ways. This at a time when there's a ton of other news and world events right now, as Republicans try and slam this through in less than two weeks without detailed scoring. That is a big break for Democrats. Their outside groups were starting to engage in a major way Tuesday, but Kimmel certainly serves as a major boost for anyone who may have been caught flat-footed by the speed with which this is moving.

About the process:

It has been fascinating talking to former staffers -- and some current -- about how this is all coming together -- not that Republicans are once again on the brink of repeal and replace, but the process itself. Stunned is one way to describe it. Very uneasy would be another. "Horrified" was what one former GOP legislative counsel told me.

It has become a pretty clear position of leaders for years that when you have the votes you vote, and when you have a top-ranked agenda item hanging in the balance, you do whatever you can to slam it through, then figure it out later. Both parties hands are dirty in this.

But this scenario is something really jarring to a lot of former Hill staffers -- most notably former GOP health care staffers now on K Street.

Think about it -- introduce a 140-plus-page bill that would institute a dramatic shift in US health care, spend two weeks making changes to appeal to members/various constituencies, pass it and boom, that's it. There are no do-overs. No chances to fix this in the House rules committee or on the House floor or in a conference. No technical changes. No new amendments after the Senate floor.

The bill could end up being the best thing ever for health care, but the speed with which is is moving is destined to create unintended consequences. "It can be just three words out of place -- a technical fix, basically -- that end up causing major problems down the road," one aide noted of the high wire act of sorts.

The legislative counsels and staffers working on this are highly regarded and are as good at their jobs as anyone in the business, no question about it, but think of it this is way: "Nobody writes perfect legislation," one lobbyist who used to work on the Hill told CNN. "And nobody can perfect legislation in two weeks, let alone legislation as consequential as this."

This story has been updated.