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Senate Majority Leader Mitch McConnells new plan is to ask Republicans to suspend reality until after casting their vote: Regardless of what the bill actually says, it means whatever they want it to mean.

To state the obvious, this is not exactly a strong position. Conservatives will believe they are being betrayed, while Republicans (and everyone else) who want to preserve Medicaid wont believe the reassurances.

McConnell, whether his reputation as a master legislative technician is deserved or not, is no fool. He simply has only a few choices remaining at this point in the game. Playing pretend is one of the last tools left at his disposal.

The bottom line remains where its been since January: Very few congressional Republicans want to be responsible for the changes that repeal-and-replace would produce including, of course, taking health insurance away from millions of Americans. Even fewer want to be responsible for killing the item at the top of the Republican rhetorical agenda since spring 2010.

At the same time, theres a group of very conservative members who want to take advantage of a rare unified government opportunity to roll back major parts of the Great Society.

Theres just no way to square that circle.

And House Speaker Paul Ryan, for better or worse, has done an excellent job of boxing McConnell in. Ryan was able to get something through the House by basically using the same logic McConnell is attempting now: Secure the support of various factions by promising that their objections would be dealt with later on in the other chamber. That was sufficient for those who were unhappy with the House bill but didnt want the blame for defeating it.

And then Ryan has made it clear (or at least effectively bluffed) that the House will accept intact whatever the Senate will do, making it harder for McConnell to do the same thing senators believe that anything they pass will wind up as law, and theyll be liable for the effects.

Republicans have become increasingly desperate over the last few months to find a way to fulfill their campaign pledge to repeal and replace Obamacare.

But their streak of mistakes began years earlier. There have been many, many off-ramps available since the Affordable Care Act was signed well, really, since the original bill first hit Congress.

Republicans had plenty of chances to shift to fixing the health care system instead of claiming they were able to fully replace the status quo. Or they could have defined repeal and replace as something that they really could have accomplished.

Or they simply could have declared victory and moved on to something that was more promising for them, such as taxes in other words, they could have gone with a pretend and rename version of repeal and replace.

Its still not clear what the fate of this legislation might be. The surface problem remains the same: Its hard to satisfy the very conservative demands of Rand Paul, Mike Lee, and Ted Cruz without losing the votes of the least conservative Republican senators such as Dean Heller, Lisa Murkowski and Susan Collins and vice versa.

But I think the underlying question remains a more basic one: Do Republicans really want to pass a bill? Not just are they willing to vote for it, but do they really care about getting this done?

If they do, its likely that compromises will eventually be found. If they either dont want to pass anything or, more likely, just dont feel all that strongly about it, then they probably wont.

What goes into the answer to that question are several things:

Basic political calculations is it worse to break their promise on repealing Obamacare, and taking responsibility for managing a law they never supported in the first place or is it worse to be stuck with responsibility for the replacement?

Policy considerations they may really care about the effects of the status quo compared to the replacement bill in their districts and across the nation. And who knows what other considerations any of the 52 Republicans might have.

Its anyones guess what that adds up to. But I certainly dont hear very much enthusiasm about the bill from any congressional Republicans so far. That might (might!) be the most important hint about what is about to happen.

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Jonathan Bernstein: Republicans are running out health care reform options - Omaha World-Herald