Donovan Slack, and Erin Kelly

USA TODAY

WASHINGTON — President Trump headed to Capitol Hill on Tuesday to make a personal pitch to Republicans on the bill to repeal Obamacare, making clear to them how important it is they stay united to pass the legislation and keep a key campaign promise of his and also of theirs.

"The president of the United States came to us and said, 'We made a promise to the American people and we need to keep our promises,' " said House Speaker Paul Ryan, R-Wis. "The president was very clear and he laid it on the line for us."

Ryan said Trump did "what he does best — and that is to close the deal."

"The president just came here and knocked the ball out of the park," he said.

The personal entreaties from the president come as Republicans on Monday night released a modified version of the legislation seeking to win over more conservative votes. Under those changes, states could require able-bodied Medicaid recipients without dependents to work beginning in October. States also could receive Medicaid funding as a lump sum instead of a per capita allotment. The revised bill also would repeal taxes on the wealthy, the insurance industry and others in 2017 instead of 2018.

House leaders are planning to bring the measure up for a vote on Thursday, the seventh anniversary of the Affordable Care Act.

As he headed inside the Capitol, Trump gave a thumbs-up, and when asked whether he thought he would have enough votes to pass the bill, he said, "I think so." He emerged with the same optimistic tone, telling reporters, "I think we're going to get a winner vote."

"We're going to have a real winner. It was a great meeting. They're terrific people," Trump said. "They want a tremendous health care plan, which we have. There are going to be adjustments made. I think we'll see the votes on Thursday."

Not everyone was convinced, however. Rep. Dave Brat, R-Va., a member of the conservative Freedom Caucus, said he still won't support the bill.

“We’ve got to get the prices down," he said, which under the current version doesn't happen until the third year after passage. Brat said many people are focusing on how many people will be covered, but he and other fiscal hawks are looking at premiums and other factors.

Ryan maintained that many other Freedom Caucus members will support the legislation. He said there are "huge conservative wins" in the bill, including massive tax cuts and anti-abortion provisions that members requested. The Freedom Caucus has opted not to take a position on the bill, allowing individual members to announce their stances.

Ryan said the choice for members comes down to: "Do you want to stay with the Obamacare status quo?"

However, Dan Holler, the vice president of the conservative Heritage Action for America, said the group will continue to urge lawmakers to vote against the bill unless more Obamacare regulations are repealed in the legislation. The conservative Club for Growth also announced Tuesday that it is launching a $500,000 digital ad campaign in the congressional districts of 10 House members, calling on them to reject "RyanCare."

"The RyanCare bill fails to keep President Trump’s promises of interstate competition and health insurance deregulation," said Club for Growth President David McIntosh. "Republicans promised a bill that would stop Obamacare’s taxes and mandates, and replace them with free-market reforms that will increase health insurance competition and drive down costs. RyanCare fails on those counts."

Ryan said some of the things that Republicans are seeking, such as allowing consumers to buy insurance across state lines, cannot be included in the bill because they would violate the budget rules that allow Republicans to push the legislation through the Senate with a simple majority of 51 votes. There are 52 Republicans in the Senate. However, GOP leaders said those issues will be taken up in separate legislation, which would require Democratic support in the Senate.

The effort is the first legislative test for Trump — and a heavy lift. Even if the bill passes the House, getting it through the Senate will be difficult.

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The bill as it stands would eliminate the mandate that individuals buy health insurance or face a tax penalty. Instead, they could pay a fine if uninsured for longer than 90 days. It would also change tax credits for low-come Americans to buy insurance and repeal the law's tax increases on the wealthy, insurance companies, drugmakers and others. It would still allow adult children to stay on their parents' plans until age 26 and prohibit insurance companies from denying coverage based on pre-existing conditions.

The nonpartisan Congressional Budget Office has predicted the legislation would increase the number of uninsured by 14 million in 2018 and by 24 million by 2026 while also reducing the deficit by nearly $340 billion.

The difficulty for Trump and House GOP leaders is that the changes they are making to appease conservatives may make the bill harder to pass in the Senate, where moderate Republicans are worried about the impact of Medicaid cuts on low-income people, seniors in nursing homes, and Americans who need treatment for opioid addiction.

Ryan said House leaders are trying to be careful.

"We don't want to put something in the bill that the Senate is telling us is fatal to the bill," he said at a news conference Tuesday.

If the bill passes the House, it will undoubtedly be amended in the Senate. Senate Republicans are looking to make some significant changes, including expanding subsidies for older, low-income Americans, who would end up paying much more under the House legislation than they do under Obamacare.

If the Senate passes a bill, negotiators from the House and Senate will have to try to reach consensus on final legislation.

It was unclear until recent days just how much skin the new president had in the game, despite the repeal of Obamacare being a central campaign promise. News reports last week suggested he might not take full ownership of the issue, but he has since taken it on, including at a rally in Louisville, Ky., on Monday night.

“This is our long-awaited chance to finally get rid of Obamacare,” Trump exhorted the crowd.

He did appear to cast it at times more as something that just needs to be done in order to get to other legislative priorities, such as reducing taxes, “one of my truly favorite things,” he said.

Brat said Trump hit the same theme during Tuesday's meeting on Capitol Hill. “He wants to pass this because we all want to move onto tax reform,” he said. Brat said he isn't worried about Trump turning his Twitter wrath against him and other Freedom Caucus members who are up for reelection in 2018 if they end up sinking the bill.

“We can defend our position intellectually, and that’s all that matters,” he said.

Democrats, meanwhile, continued blasting the legislation, including the modified version. House Minority Leader Nancy Pelosi, D-Calif., said “Republicans are trying to put lipstick on a pig."

"No matter how the Republicans try to dress it up, TrumpCare is a plan to push 24 million people off their health coverage and force Americans to pay more for less health care," she said.

Senate Minority Leader Chuck Schumer, D-N.Y., echoed similar sentiments.

"Republicans are desperately trying to save this bill," he said, but added that the changes "amount to a fresh coat of paint on an old jalopy."

White House Press Secretary Sean Spicer said Trump will continue meeting with lawmakers in the coming days, and he reiterated that the legislation is just one part of the health care overhaul envisioned. Spicer said Tom Price, Secretary of Health and Human Services, also will make administrative changes, and he reiterated that later bills would make further changes, including allowing the sale of health insurance across state lines.

"I think the president continues to engage members; he will continue to do that through Thursday," Spicer said. "We feel very good going into the final stretch."

Contributing: Eliza Collins