Vice President Pence, right, and White House Office of Management and Budget Director Mick Mulvaney arrive at a meeting of House Republicans on Capitol Hill on April 4, 2017, in an effort to revive a push to repeal the Affordable Care Act. (Aaron P. Bernstein/Getty Images)

House Republicans indicated Wednesday that they would leave Washington this week without passing their stalled health-care bill, spurning a spirited White House effort to revive the legislation amid a fresh round of intraparty finger-pointing.

Three top GOP leaders each dialed back expectations for action before a two-week recess begins Thursday, after a late-night meeting of holdout factions led by Vice President Pence on Tuesday failed to produce a breakthrough.

“We can keep working this for weeks now,” House Speaker Paul D. Ryan (R-Wis.) said Wednesday morning, emphasizing that there was “no artificial deadline” for action.

“Getting this done by tomorrow? I think that’s tough,” said House Majority Leader Kevin McCarthy (R-Calif.), a view that was echoed by Majority Whip Steve Scalise (R-La.), who said it was “very unlikely” the health-care bill would be voted on this week.

[Republicans try to revive health-care effort as leaders seek to temper expectations]

(Jenny Starrs/The Washington Post)

A continuation of a meeting that began Tuesday night was not expected Wednesday as originally planned, foreclosing any chance that the GOP’s American Health Care Act might be resurrected before the Easter recess begins. However, late Wednesday, Ryan was asked to meet with Pence at the White House, with health care the primary topic, according to House GOP and White House aides. Ryan also met briefly with Trump, a Ryan aide said.

“It’s alive, and we’re making progress,” Ryan said Wednesday night in an interview on NPR. But, he added, “it’s going to take a little bit of time.”

The impasse reflects the ongoing inability of the GOP’s moderate and hard-right wings to reach a compromise on just how much of the Affordable Care Act, signed into law eight years ago by President Barack Obama, ought to be undone. The conflict has persisted despite the sky-high political stakes for congressional Republicans who have long promised to repeal the law, as well as President Trump’s desire to notch a victory with only a handful of legislative workdays remaining in his first 100 days in office.

Rep. Patrick T. McHenry (R-N.C.), the chief deputy whip, said the recess could be a “cooling-off period” during which holdouts could “listen to their constituents and justify their position on this bill.”

“You need people to stop, take a deep breath and think through the way to yes,” McHenry said. “Right now, the offerings have diminished votes, not increased them.”

What has filled the void is more blame-casting, with conservatives outside of Congress arguing that the latest standstill lies in the hands of the GOP moderates — a narrative counter to the one pushed by Trump and House leaders, who have blamed the hard-right House Freedom Caucus.

Michael Needham, chief executive of the conservative group Heritage Action for America, said Wednesday morning on a call with reporters that the moderates had “abandoned” efforts to find compromise.

House Speaker Paul D. Ryan (R-Wis.) at a news conference April 4, 2017, on Capitol Hill. (J. Scott Applewhite/Associated Press)

[Trump and House conservatives say a new health-care deal is possible. We’ve been down this road before.]

“It calls into question their commitment to the basic tenets of the Republican Party,” Needham said. “It may be time to spend a couple of weeks trying to explain and educate and build support for good ideas.”

According to Needham, as many as 20 members of the Freedom Caucus had been ready to support a more conservative proposal, one that would have allowed states to undo most of the Affordable Care Act’s insurance mandates — provisions that conservatives say are driving up insurance prices — but moderates balked.

Rep. Mark Meadows (R-N.C.), the chairman of the Freedom Caucus, argued Tuesday that conservatives have retreated plenty as the health-care debate has progressed.

“We’ve been giving,” he said. “We started out with wanting to repeal all of Obamacare, then we backed off to repealing some of Obamacare and repealing all of the taxes. Then we backed off to saying, ‘Well, we can repeal some of Obamacare and some of the taxes.’ Now we’re down to just a few fundamental issues. . . . Premiums for the people we serve have to come down, and if they don’t come down, we will have failed.”

Rep. H. Morgan Griffith (R-Va.), a Freedom Caucus member who was prepared to vote for the earlier bill, agreed that moderates share some of the responsibility for the bill’s failure.

“While we were discussing and trying to convince some of my colleagues to hold their nose and vote yes, suddenly we had major defections from the center,” he said.

But Griffith said the blame game wasn’t helping anyone: “You can’t do it on one side without the other. Some of my friends on the right need to figure out that we can’t get everything that we want. Some of my friends in the center need to figure out that they can’t get everything they want. But we’ve got to do something positive for the American people.”

Moderates, meanwhile, rejected the notion that they were at fault for the health bill’s failure.

Rep. Tom Reed (R-N.Y.), a member of the moderate Tuesday Group, said the party’s centrist faction is “always wanting to get to yes and to govern” — a pointed criticism of Freedom Caucus members who have routinely broken with GOP leaders to vote against major bills.

“To somehow try to transfer this obstructionism to us governing members, to me, is just a sign that maybe they may have overplayed their hand, and I think they’re feeling the ramifications of that,” he said.

Said Rep. Adam Kinzinger (R-Ill.), another Tuesday Group member: “I know why the original [bill] failed, and I know who’s to blame for that. . . . When we were really close to getting this passed, there was one group that stopped it.”

But the problems with the bill have gone beyond ideology. Many rank-and-file House Republicans — particularly members of the committees that wrote the bill — are concerned that they have essentially been sidelined from the negotiations.

“Many of us on the committees have spent years on these policies, and to just see it kind of being pulled away and put behind the scenes potentially to me is not the wisest course to take,” said Reed, a member of the House Ways and Means Committee.

And there continues to be wariness across the House GOP of moving too fast on a major bill that could potentially affect one-sixth of the U.S. economy. Recent polls have found dismal public opinion of the GOP plan, and a Gallup poll released Tuesday found the ACA’s popularity at an all-time high.

Rep. Pete Sessions (R-Tex.), chairman of the House Rules Committee, said it was unrealistic to think that the bill could be resurrected in a matter of days after significant changes.

“For us to vote on something that we have not explained to people back home would be a pretty difficult move for most members,” he said. “Republicans have said we would go home and talk with people back home about where we are and what we’re doing. And that, in my opinion, has not occurred.”

The most recent push to revive the bill came as Trump renewed attacks on the Freedom Caucus and its leaders. But while Trump was tweeting attacks, White House officials wondered whether they could shape a deal around the concept of federalism — that is, allowing states to apply for waivers from the ACA mandates.

Pence and other administration officials broached the idea with the various House factions over the weekend, then met separately Monday with the Freedom Caucus and the Tuesday Group. Both congressional groups left thinking there might be a path to a deal, but both had made different assumptions about what that deal might involve.

Conservatives thought that what was on offer would allow states to opt out of many ACA mandates aimed at protecting those with preexisting medical conditions, people who would instead be covered through subsidized state-based high-risk pools. The moderates, however, believed the waivers would be much less extensive.

“I think what everybody heard is that we want a deal,” Meadows said. “And so when you hear that you want a deal, you’re willing to latch onto whatever is most important to you, and that’s just human nature.”

The two-hour Tuesday meeting — brokered by the Republican Study Committee, a larger group of House members that includes Freedom Caucus and Tuesday Group members — involved Pence, White House Chief of Staff Reince Priebus, Health and Human Services Secretary Tom Price, leaders of both House factions and key committee chairmen. But the meeting broke up without a clear resolution — or even the text of a potential proposal for the various factions to review.

McHenry said Wednesday that rolling back the ACA mandates that protect those with preexisting conditions would be a nonstarter — given what Trump, Ryan and many other Republicans had said on the campaign trail.

“It goes counter to the president’s promises. It goes counter to the promises of more than 200 members of the House,” McHenry said. “It’s not a ‘moderate problem.’ It’s a math problem.”

John Wagner, Ashley Parker and Paige Winfield Cunningham contributed to this report.

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