SEN GOP TRYING TO GET TO YES ON TRUMPCARE BILL.

Ted Cruz leaves the Senate floor after a vote yesterday. The Texas senator is one of the holdouts on the health care bill, but he's widely expected to come around. (Astrid Riecken/For The Washington Post)

There are not currently the 50 votes necessary to advance the legislation that Mitch McConnell unveiled Thursday. There will need to be concessions and compromises, and there are several ways the push could still fall apart in the coming days.

But pretty much every Republican, including the current holdouts, wants to pass something. And no GOP senator wants to bear the brunt of the blame from the base for inaction. That factor must not be discounted.

-- President Trump, who endorsed the Senate bill last night, also badly wants to get something done, and he’s made clear that he’ll sign whatever makes it through Congress.

-- An NBC News/Wall Street Journal poll, which was in the field earlier this week and published yesterday, helps explain the balancing act we’re seeing from so many Republicans: Only 16 percent of Americans believe that the House health care bill is good, down from 23 percent last month. Even among Republicans, just one in three view the measure positively. But the public is basically split down the middle over Obamacare, with 41 percent saying the 2010 law is a good idea and 38 percent saying it’s a bad idea. Asked if Congress and the president should continue their efforts to repeal and replace the Affordable Care Act, the split is similar: 38 percent say yes, 39 percent say no, and 20 percent have no opinion. But here’s the rub: 71 percent of Republicans want Congress to continue its effort to repeal the ACA, and only 12 percent of GOP voters want to move on. Independents also slightly favor forging ahead with repeal, 38 percent to 32 percent. Those numbers demonstrate why lawmakers are eager to be perceived as extracting concessions (so they can say they made improvements), but the partisan breakdown also shows why most GOP senators are willing to get behind what remains an unpopular piece of legislation. Even as they do so, however, they are carefully positioning themselves. A bunch of Republicans who will vote yes next week released noncommittal statements yesterday suggesting that they are keeping an open mind. McConnell outlines Senate health-care proposal -- McConnell can only afford two defections, and he’s facing objections from the right and the middle. But if anyone can thread this needle, it’s the Senate majority leader. “McConnell unveiled his proposal knowing full well that — as currently written — it lacks the votes to win approval,” congressional correspondent Paul Kane writes. “But using a time-honored tactic of congressional leadership, the Kentucky Republican decided it was time to call the bluff of his GOP colleagues. … Republicans now head into five or six days of intense negotiations … Many GOP senators complained bitterly about the secretive process, while privately breathing a sigh of relief that they didn’t yet have to take a position on the emerging legislation.” Pemiscot Memorial, the public hospital in one of Missouri's poorest counties, depends on Medicaid funding to survive, its CEO says. Bram Sable-Smith/Side Effects Public Media ---- WHAT YOU NEED TO KNOW ABOUT THE SENATE BILL— -- The Congressional Budget Office said it expects to release a score for the Senate bill “early next week.” -- Despite grumbling from some members of his conference, McConnell still plans on holding a final vote next week. (Sean Sullivan, Kelsey Snell and Juliet Eilperin) -- Democrats have little power to stop the vote from occurring....  Like the bill that passed the House last month, the Senate measure phases out expanded Medicaid funding for states, but it does so more gradually between 2020 and 2024. -- But because of an accounting gimmick, the Senate bill guts Medicaid much more drastically over the long-term than the House bill. Max Ehrenfreund reports... -- The Medicaid cuts in the Senate proposal could disproportionately hurt rural hospitals, 700 of which across the country already teeter on the brink of closure. (NPR’s Bram Sable-Smith) -- The Senate bill would cut almost $1 billion in funding for the Prevention and Public Health Fund, which provides 12 percent of the CDC’s budget, starting this October. Lena H. Sun reports: “The money supports programs to prevent bioterrorism and disease outbreaks, as well as to provide immunizations and screenings for cancer and heart disease … About $625 million goes directly to states and communities to address their most pressing health needs, including drug misuse, infectious diseases, lead poisoning, obesity, diabetes, hypertension, cancer and tobacco use.” The Senate bill provides smaller subsidies for less generous health insurance plans with higher deductibles. The Affordable Care Act provides government help to anyone who earns less than 400 percent of the federal poverty line ($47,550 for an individual or $97,200 for a family of four). The people who earn the least get the most help. The Senate bill would make those subsidies much smaller for many people, and only provide the money to those earning less than 350 percent of the poverty line ($41,580 for individuals and $85,050 for a family of four). The Senate bill will tether the size of its tax credits to what it takes to purchase a skimpier health insurance plan than the type of plans Affordable Care Act subsidies were meant to buy. Essentially, these tax credits buy less health insurance -- The bill appropriates only $2 billion in fiscal year 2018 to address the opioid drug epidemic, Vox’s Ella Nilsen reports. This is less than the $45 billion over 10 years that Republican Sens. Rob Portman and Shelley Moore Capito requested and far less than $190 billion over 10 years, which is what a Harvard health economics professor estimated this week was needed to truly address the problem. The Senate bill repeals the individual mandate — and replaces it with a six-month waiting period. The bill gets rid of the Affordable Care Act’s unpopular requirement that nearly all Americans carry health coverage or pay a fine. The most recent version of the proposal includes a six-month waiting period for those who want individual coverage but have had more than a two-month break in coverage in the last year. The bill would cut taxes for the wealthy. Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that. Photo by Chip Somodevilla/Getty Images The Senate bill defunds Planned Parenthood for one year. This would mean Medicaid patients could no longer seek treatment at Planned Parenthood clinics. Experts expect this would result in low-income Americans getting less medical care and having more unintended pregnancies, as access to contraceptives would decline. All in all, the replacement plan benefits people who are healthy and high-income, and disadvantages those who are sicker and lower-income. The replacement plan would make several changes to what health insurers can charge enrollees who purchase insurance on the individual market, as well as changing what benefits their plans must cover. In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees who rely on the law’s current requirements, and would be asked to pay more for less generous coverage. -- Both House leaders, Paul Ryan and Nancy Pelosi, argued that the Senate bill is not radically different from what their chamber passed last month.  A protester being removed from outside the office of Mitch McConnell on Thursday .CreditSaul Loeb/Agence France-Presse — Getty Images ------ -- One way to think about all of this: Obamacare cut the uninsured rate almost in half by redistributing resources from the wealthy to the poor. This bill seeks to undo that redistribution, The New York Times’ Margot Sanger-Katz explains. Sarah Kliff summarizes it this way on Vox: “The bill asks low- and middle-income Americans to spend significantly more for less coverage.” STAKEHOLDERS PANNED THE BILL: -- Hospitals decried the cuts to Medicaid, with the chief executive of the American Hospital Association calling them “unsustainable.” (Juliet Eilperin) -- The AARP said the Senate bill allows insurance companies to charge the elderly up to five times more than young people. The senior’s lobby is mobilizing its membership against what it calls an “age tax.” (The Hill) -- A chorus of providers warned that the Senate bill would “turn back the clock on women’s health.” “This legislation deliberately strips the landmark women’s health gains made by the Affordable Care Act and would severely limit access to care,” the president of the American Congress of Obstetricians and Gynecologists wrote in a statement. -- One exception: Insurance executives are happy because the Senate bill reverses a provision in Obamacare that penalized their companies for excessively paying top staff. (Ehrenfreund)