With the support of the White House, Republican leaders in Congress are once again engaged in a full court press to squeeze out 50 votes for a new GOP plan to overhaul the Obama health law, but in what's almost a repeat of the last showdown vote earlier this year in the Senate, the decisions of a handful of GOP Senators will make or break this latest effort on Obamacare.
"My message today is I want to make sure that members of the Senate know the President and our entire administration supports Graham-Cassidy," said Vice President Mike Pence, who interrupted his work at the United Nations General Assembly to fly back to Washington, D.C., so he could rally GOP Senators behind this new health care push.
"There is positive momentum," Sen. Ted Cruz (R-TX) told reporters about the plan, named for Sen. Lindsey Graham (R-SC), and Sen. Bill Cassidy (R-LA), as Republicans were envisioning a vote next week, before a September 30 deadline for action in the U.S. Senate under the expedited rules of 'budget reconciliation,' which does not allow for a Senate filibuster.
But as of now, there still aren't enough votes for Graham-Cassidy, and Senate Majority Leader Mitch McConnell on Tuesday made no guarantees that the plan would get a vote in the full Senate.
"We would have to act before September 30," McConnell told reporters. "Everybody knows that the opportunity expires at the end of the month."
The plan would send chunks of money to the states, and let them figure out how best to provide health insurance to people who don't get coverage through their jobs, or the non-group insurance market, an idea that has received strong support from GOP lawmakers in the Congress.
"This is an entirely different bill," said Sen. David Perdue (R-GA), who said he hoped some of those who had voted "No" in the summer would change their minds.
"This is a much better step forward than staying with Obamacare," Perdue said.
But as with an earlier attempt to approve a health care bill this year in the Senate, a handful of familiar Senators will determine the outcome: Sen. John McCain (R-AZ), Sen. Lisa Murkowski (R-AK), Sen. Susan Collins (R-ME), Sen. Shelly Moore Capito (R-WV) and Sen. Rand Paul (R-KY).
Paul has repeatedly said he cannot embrace the Graham-Cassidy plan, arguing that it leaves in place too many of the Obama health law's taxes and structure, and simply shuffles large amounts of money to the states.
Collins has said she is leaning against the bill, Capito remains publicly undecided, McCain has agonized about the process, but not ruled out the possibility of voting for the bill, and Murkowski - who cast a crucial vote against the GOP 'skinny' bill - remains on the fence.
"This chamber is deeply divided on what to do on health care policy," Collins said on the Senate floor Tuesday afternoon.
Some Republican Senators are still pushing for changes in the Graham-Cassidy plan, trying to prevent states run by Democrats from using the money to set up a single-payer system in their own states.
Outside the Capitol, a bipartisan group of Governors made clear their opposition to the plan, arguing against a solution from just one party.
In a letter signed by 5 Democrats, 4 Republicans, and one Independent, the Governors endorsed "bipartisan efforts to make health care more available and affordable for all Americans."
"Only open, bipartisan approaches can achieve true, lasting reforms," the Governors of Colorado, Montana, Virginia, Pennsylvania, Louisiana, Ohio, Massachusetts, Nevada, Vermont and Alaska wrote.
With floor activity truncated this week by Rosh Hashanah, the Senate will not have votes again until Monday, and it still isn't clear when - or whether - the Senate Majority Leader will try to move to the Graham-Cassidy bill next week.
But the clock is ticking.
With Yom Kippur starting on September 29, the Senate will only have a few days next week to act on health care before the special "budget reconciliation" authority runs out in the Senate.
And it's still not clear if the GOP can find 50 votes.