Mitch McConnell is bringing down the hammer on Obamacare repeal.

As pessimism mounted among Republicans about advancing any health care bill this week, the Senate majority leader took a tough tack Monday, warning his caucus that a critical vote Tuesday is the only way Republicans can even begin to make changes to Obamacare. McConnell also met with a coalition of outside conservative groups that are amping up pressure on wavering GOP senators.

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“I know many have ideas on how to improve health care,” McConnell said on the Senate floor. “The only way we’ll have an opportunity to consider ideas is if senators are allowed to offer and debate them. That means voting to begin the open amendment process.”

In private, McConnell was more blunt, telling the activists that Republicans who oppose a key procedural vote on Tuesday to advance debate on Obamacare repeal are effectively endorsing the Democratic health care law.

“You either vote for the motion to proceed, or it is a vote for the status quo,” McConnell told the groups, according to Tea Party Patriots co-founder Jenny Beth Martin, paraphrasing the Republican leader.

McConnell and his leadership team are urging the GOP caucus to cough up the 50 votes needed to begin debate on nixing the Democratic health care law — even though Republicans aren’t even sure what they’ll be voting on and no proposal has the votes to pass. If McConnell’s gambit fails by just one vote, Republicans hope they can take another shot if and when Sen. John McCain (R-Ariz.) returns from cancer treatment.

Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) are being treated as lost causes in informal whip counts, presumably dooming the measure out of the gate. To get to 49, a half-dozen other skeptical GOP senators would have to be persuaded.

The fact that senators still don’t know exactly what they’ll be voting to begin debate on has opened GOP leaders to criticism about the process and further complicated their task.

“It’s a big misunderstanding,” Senate Majority Whip John Cornyn (R-Texas) said Monday of concerns leading up to the vote. “Everybody’s going to get a chance to vote on everything.”

Still, Sen. Orrin Hatch (R-Utah) said he expects the Senate to vote on “some version” of the 2015 bill to repeal Obamacare with no replacement. He expects the vote to start debate will be successful.

When asked why he thinks that when many others are predicting failure, Hatch said, “There are a lot of folks who’ve gotten their heads kicked in, too.”

In addition, the Senate parliamentarian has raised a number of questions about whether key provisions can even survive the chamber’s byzantine rules.

McConnell had said last week that a repeal-only bill would be the first amendment up if the Senate opens debate on repeal. But the option has been squashed.

“That creates some heartburn on the part of some of our members. So whatever we need to do to get on the bill to get started,” we’ll do, Cornyn said. Asked whether the GOP would succeed in opening debate, he said: “That’s the goal.”

Over the weekend, Republicans haggled over which amendments would get first dibs for votes if they did agree to let the debate advance. Sen. Rand Paul (R-Ky.) wants a quick vote on his call for a straight Obamacare repeal. But Collins, Murkowski and Sen. Shelley Moore Capito (R-W.Va.) oppose scrapping the law without a clear alternative.

“Our members are discussing the order of amendments,” said Don Stewart, a spokesman for McConnell.

McConnell needs a sea change in the next 24 hours in order to get even close to 50, but there have been slight signs of movement. For one, anti-abortion and conservative groups have been pressuring wavering Republicans to get on board with the procedural vote.

Capito, who has opposed the various GOP repeal bills because of their steep cuts to Medicaid, will spend Monday evening with President Donald Trump. She’s been sounding more open lately to allowing the debate to advance, saying that last week Trump “assured me we are on the same page when it comes to repealing and replacing Obamacare.”

“Republicans have a last chance to do the right thing on Repeal & Replace after years of talking & campaigning on it,” Trump said on Monday morning.

Sens. Dean Heller (R-Nev.) and Rob Portman (R-Ohio) are also question marks. Heller has taken a particularly hard line against voting for anything that could leave his low-income constituents with fewer benefits, and voting to move ahead on Tuesday would mark a swift reversal of his previous criticisms of the bill.

“If Capito and Heller stay as no, it’s clear we are dead,” said a Republican familiar with internal deliberations. “If they flip to yes … there will be pressure to try again when McCain comes back.”

Those more centrist senators might need reassurances they would be voting to move on to a repeal and replace bill, not just a repeal bill. But Sen. Mike Lee (R-Utah) and Paul would likely need different guidance from party leaders that a more fulsome repeal is in order to succeed.

Convincing those factions to trust McConnell and the process would require a major leap of faith, but that’s what Republicans are counting on.

“We should proceed to take it up and honor our promise to repeal Obamacare,” said Sen. Ted Cruz (R-Texas) as he entered McConnell’s office on Monday afternoon.

In another problem for Republicans, the Senate parliamentarian indicated Friday that several provisions in the GOP health care measure violated the so-called Byrd rule and would need 60 votes on the Senate floor to remain in the bill.

Among the provisions flagged by parliamentarian Elizabeth MacDonough is language that would defund Planned Parenthood, ban abortion coverage in Obamacare plans, end a requirement that Medicaid cover certain minimum services starting in 2020 and allow states to determine how much insurers have to spend on medical care. GOP aides are already reworking some of the problematic provisions.

One idea under consideration is to broaden the defunding amendment so that it would or could apply to more entities than Planned Parenthood, according to sources working on the issue. That would counter the parliamentarian guidance that the earlier version targeted Planned Parenthood.

Conservatives are also hoping the GOP can repair their abortion restrictions for plans on insurance exchanges by funneling those tax credits through other programs, like Medicaid or the Children’s Health Insurance Program. Those are already barred from using taxpayer funds to cover abortion with some exceptions.

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