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Why the Senate health care bill is in trouble, in 2 quotes

(CNN) When Republicans left Washington last week, the Senate's attempt to overhaul the Affordable Care Act was in grave condition.

Time doesn't appear to have helped things much.

Consider these two quotes from opposite ends of the Republican spectrum:

1. Maine GOP Sen. Susan Collins: "There was only one issue. That's unusual. It's usually a wide range of issues. I heard, over and over again, encouragement for my stand against the current version of the Senate and House health-care bills. People were thanking me, over and over again. 'Thank you, Susan!' 'Stay strong, Susan!' " (Washington Post, 7/4)

2. Kentucky GOP Sen. Rand Paul: "The bill is just being lit up like a Christmas tree full of billion-dollar ornaments. And it's not repeal." ("Fox News Sunday," 7/2)

Neither of those quotes sound like there's much softening from either senator in their opposition to the current version of the health care bill. In fact, both quotes suggest that Paul and Collins are even more convinced that they need to continue to oppose the legislation.

If that happens, Senate Majority Leader Mitch McConnell can't lose a single other Republican senator or the bill will fail. That's a very, very thin line for McConnell to walk -- particularly given that seven senators other than Collins and Paul had signaled their opposition to the current version of the health care bill before heading out of Washington last week.

Lose just one of those seven and Republicans' much-ballyhooed seven-year promise to repeal and replace Obamacare fails -- despite the fact that the GOP controls the House, Senate and White House.

The quotes above from Collins and Paul are exactly why McConnell pushed so hard to hold a final vote on the health care bill before the July 4 recess. He understood that more time wouldn't solve the problems senators had with the bill, it would only harden those problems -- and their resolve not to be for the legislation.

Put yourself in Susan Collins' shoes for a minute. She is already very concerned about the bill. She goes home to Maine. Everyone tells her -- and it sounds like everyone told her -- that she's doing the right thing by opposing it. She is still thinking about running for governor of Maine in 2018. And, as the Boston Globe's James Pindell rightly notes, those losing insurance under this legislation would be disproportionally older people and those living in rural areas. Maine has lots of both.

Aside from doing McConnell a solid, there's no good reason for Collins to be persuaded to be for this bill. And, there's lots (and lots) of reasons for her to be against it.

Ditto Paul. He's built his reputation in the Senate as a purist -- someone who won't bend to the prevailing political winds. He pledged full repeal and, damn it, that's what he wants. Anything short of full repeal is, in Paul's mind, a capitulation, and would likely be viewed in a similar light by those who have supported him.

It's those sorts of realities that the likes of Ted Cruz (Texas) and Mike Lee (Utah) on the conservative side and Rob Portman (Ohio) and Lisa Murkowski (Alaska) in the centrist wing have to confront. And, if even one of them decides it doesn't make policy or political sense to be for the bill, the gig is up for McConnell.

There's always the possibility that McConnell -- through a handful of strategic tweaks -- finds a way to seize victory from the jaws of defeat on this. But, the jaws of defeat appear to be opening wider and wider with each passing day.

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