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Mitch McConnell is stuck between a rock and a hard place on his healthcare bill — but don't count him out

Mitch McConnell made the healthcare bill more conservative because he thinks he can appease moderates members in other ways.

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Senate Majority Leader Mitch McConnell is known for his dealmaking and ability to deliver a bill over the objections of some of his members.

On healthcare, McConnell's had his work cut out for him: The House bill to replace the Affordable Care Act was widely panned by Republican senators and the public, he could afford to lose only two votes on the Senate's version of the bill, and he had to get it passed with a relatively short window.

Given those pressures, it's no surprise that the Senate GOP's bill, called Better Care Reconciliation Act (BCRA), is on its third iteration and still facing an uphill battle to pass.

Despite the tough road ahead, strategists say that McConnell's penchant for cutting deals may be enough to save the BCRA.

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Since the start of deliberations on the Senate, leaders have promised to craft a more moderate bill than the House's American Health Care Act.

Given the parts of Obamacare that the BCRA kept — including its tax credit structure, slower phase out of Medicaid expansion, and funding to offset insurer costs — conservative groups took issue with the bill as too far to the center.

A former Senate GOP leadership aide told Business Insider that it was clear that McConnell was trying to ensure moderates were on board from the start.

"I think there is a very credible case to be made that this bill was center right to begin with and is still a center right bill," the former aide said.

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Despite this, many moderate members are still cold on the bill due to the fact that it'll cut $772 billion cut out of the Medicaid budget through 2026.

Sen. Susan Collins of Maine immediately jumped out against the bill, saying that it did not address her concerns and she would vote against a key procedural vote, called a motion to proceed.

Other moderates like Rob Portman of Ohio, Dean Heller of Nevada, Shelley Moore Capito of West Virginia, and Alaska's Murkowski would not commit either way on a motion to proceed.

A Portman aide told Business Insider on Thursday that the senator

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Given the relative starting point of the bill compared to the House version, conservatives immediately took issue with the BCRA.

Sen. Ted Cruz of Texas, Rand Paul of Kentucky, Mike Lee of Utah, and Ron Johnson of Wisconsin immediately came out against the bill because it kept intact too much of Obamacare's regulatory structure and taxes.

This necessitated a concession to this group by McConnell, which came in the form of a consumer freedom amendment from Cruz.

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Even after tweaking the bill and trying to goose individual members, McConnell is still facing a simple math problem.

With Paul and Collins firmly against the motion to proceed, McConnell can only lose a single vote to even bring the BCRA to the floor for debate. Senators don't like to be the one person that killed a bill, but as of now even bringing the bill to the floor is not a slam dunk.

According to a Republican strategist familiar with leadership, however, the thin margin does not mean McConnell should be counted out.

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