The fate of Obamacare repeal/replace part II isn't quite sealed yet, but the latest nose count among Republicans in Congress holds out little hope that this current iteration of Obamacare reform will meet the same end as the first one.

The Hill is reporting that at least 21 Republicans have indicated they are a "no vote" for the current legislation.  Since 23 negative votes would scuttle the bill – unless some Democrats could be convinced to vote for it – it doesn't appear that Speaker Ryan is any more inclined to bring this version of Obamacare repeal to the floor than he was the last one. 

It's unclear how dozens of other Republicans would vote this time, but the number of Republicans publicly opposed or leaning against the bill is enough to raise doubts about whether the House would pass it in its current form.

Twenty-three GOP defections would be enough to kill House Republicans' ObamaCare repeal-and-replacement plan, assuming every House Democrat votes against it.

Centrists opposed to the new bill are largely echoing Rep. Charlie Dent (R-Pa.), who said the negotiations between Meadows and MacArthur only exacerbated his earlier problems with the bill.

The legislation would allow states to opt out of some of ObamaCare's requirements and could result in people losing their current health coverage or facing much higher premiums. Dent, in an interview on MSNBC's "Morning Joe" on Thursday, said he worried that people with pre-existing health conditions might be left without insurance because of the changes, something supporters of the bill have fiercely denied.

Many members of the centrist Tuesday Group members [sic] complained that the MacArthur-Meadows amendment pushed the bill too far to the right, and they privately griped that MacArthur had shifted blame for the stalled healthcare effort from conservatives to centrists.  

The changes seemed aimed at winning over conservatives – and those efforts proved successful.

The approximately 30-member House Freedom Caucus endorsed the new bill Wednesday after opposing the earlier legislation.

In the process, however, the new bill might have lost just as many centrists.

Vulnerable GOP Rep. Leonard Lance wouldn't criticize his fellow New Jerseyan, MacArthur, but he there was nothing leadership could do to persuade him to support the revised bill.

"I might not use the phrase 'given up,' theologically or otherwise, [but] I believe the leadership knows where I stand on this issue,'" Lance told reporters.

GOP leaders are under pressure from the White House to hold a vote by President Trump's 100th day in office, Saturday. But they say they won't bring their revised bill to the floor until they secure the 216 needed GOP votes.

And right now, they acknowledge, they don't have them.

It should be noted that the White House has not yet begun a full court press to convince doubting Republicans to vote for the measure.  But if it looks this hopeless in the House, they might save their ammunition to fight another day. 

There are many reasons why Republicans are so divided on what to do about Obamacare, and yes, political cowardice is one of them.  But the practical aspects of ripping out Obamacare's numerous tentacles that have ensnared the entire health care system after six years of being in effect is equally to blame.

And let's face it: the American people love their goodies.  Offering to subsidize the health insurance for even upper-middle-class families has an appeal that makes the GOP look like Scrooges for wanting to take those Santa Claus subsidies away.

In short, the politics of Obamacare repeal, along with the difficulty of excising most of the law from the health care system without major disruption to insurance companies and consumers, makes the GOP's job all the harder.