So how might Senate Majority Leader Mitch McConnell square that circle? Perhaps the same way Ryan did. McConnell created a 13-member group to write the health care legislation. This group has been sharply criticized because it does not include any women — McConnell bypassed all five female GOP senators when creating it. Sexism, or a simple lack of consideration for equal representation, is always a plausible explanation for a shortage of female involvement in any Washington process, as women remain underrepresented in key lawmaking posts. But the initial exclusion of women from this group (McConnell now says the group is open to any of the GOP’s 52 senators) may also be about ideology. McConnell included both Cruz and Lee in the group but not Capito, Collins or Murkowski. That suggests (and some conservatives in Washington believe this is the case) that the Senate is taking the same approach toward trying to pass the health care bill that the House eventually did: Get conservatives on board and then dare more moderate members to block it.

There are a few reasons this could work. First, any Senate Republican, no matter how popular, must worry about becoming the key vote that stops the repeal of Obamacare, which is the kind of move that could draw a challenger in a GOP primary for his or her seat. Secondly, with states increasingly voting for the same party for both the U.S. Senate and president, all but three of the 52 GOP senators (Collins, Colorado’s Cory Gardner, Heller) come from states where President Trump won in 2016. In West Virginia, for example, the number of uninsured residents has dropped dramatically since the passage of Obamacare, in large part because the state chose take advantage of the bill’s provision allowing it to expand access to Medicaid. At the same time, Trump won the state by 42 percentage points in November. Given the level of support the president won in Capito’s home state, can the senator really block a Trump-backed health care proposal?

You might expect that senators’ votes will depend heavily on what is in the final version of the Senate’s health care proposal, which has not yet been fully written. But remember, the House intentionally voted on its health care legislation before the CBO could determine whether the bill would save as much money or insure as many people as legislators were promising. Ultimately, senators may also decide that the details don’t matter that much to them.