House Speaker Paul Ryan is downplaying any differences between GOP lawmakers and the president-elect on the question of curbing entitlement spending. | AP Photo Where everyone stands on today's health care vote

THE REALITY -- ‘IT’S ALL UP TO THE WHITE HOUSE NOW’ -- The health-care bill is really down to a coin flip. The mood in the Capitol yesterday was tense -- not because people were worried about failure, but because the situation was so fluid it was difficult to get a real read on what was transpiring. Even the smartest and savviest vote counters had no idea whether they will be able to pass this bill to replace the Affordable Care Act. As of publishing time this morning, House Republicans planned to bring this bill to the floor Thursday no matter what the whip count looked like. We wouldn’t be surprised if the vote came after the market closed. (NOTE: Big thanks to John Bresnahan and the best-in-class POLITICO Hill team for keeping us honest and abreast of all twists and turns.)

HERE’S THE DEAL. The conservative House Freedom Caucus -- which will meet with PRESIDENT DONALD TRUMP this morning at 11:30 a.m. -- wants to not only eliminate coverage requirements for health insurers in the Obamacare bill (known as essential health benefits), but they also want to repeal the law’s Title One, which includes rules on coverage for pre-existing conditions and allowing children to remain on their parents’ plan up to age 26. As of early this morning, the leadership and White House were cool to that proposal.


-- HFC SPOKESMAN ALYSSA FARAH (@Alyssafarah) at 11:12 p.m.: “No decisions reached. Continuing to negotiate. The Freedom Caucus continues to have serious concerns with current AHCA text.” Rep. Mark Meadows' statement http://bit.ly/2naGNNq

THE NUMBERS. The dramatic changes to this bill throw the whip count in serious flux. House Republican leaders have now lost the support of moderates like Reps. Chris Smith and Frank LoBiando of New Jersey, Charlie Dent of Pennsylvania and David Young of Iowa. Watch for other moderate Republicans who see this as an opportunity to ditch the bill without major political consequence. There are 237 House Republicans and 215 need to vote yes to pass this bill. They can lose 22 lawmakers.

THE HYPOCRISY. Republicans are doing exactly what they accused Democrats of doing in 2010. They are rewriting this bill behind closed doors in the dead of night. They are using the powerful Rules Committee to give themselves remarkable authority to bring up and vote on any bill in the same day -- known, quite ominously, as “martial law.”

THE STAKES ...

-- THE FREEDOM CAUCUS. To call this a critical moment for the House Freedom Caucus -- the clutch of conservative members in the House -- would be like calling Michael Jordan a weekend men’s league warrior. If the Freedom Caucus succeeds in getting the changes it wants and doesn’t put up the votes for the bill, their future negotiating stance will be seriously diminished. Even if they get half of what they want -- just eliminating essential health benefits -- and don’t put up some votes, it will be problematic in Trump’s eyes. But if they succeed here, they have the keys to the castle. If they get the changes they want, and help push this bill across the finish line, their negotiating tactics -- forcing changes at the last minute -- will be completely validated.

-- PAUL RYAN. The House speaker crafted the legislative sequencing of 2017 -- health care repeal first and tax reform second. People close to Ryan know a defeat here will be a critical blow for the Wisconsin Republican, but they say that he cares little about his long-term political standing in the House, so he’s willing to get down and dirty. But there’s no doubt that not passing this bill would sow distrust in the West Wing, and put in doubt the leadership’s ability to shepherd the rest of the GOP’s agenda. A victory here would be big for Ryan -- at least in the short term.

-- DONALD TRUMP. The president ran on being able to handle these situations better than anyone else. He always said that it was him, and him alone, who could close these deals. Remember? ‘We don’t make good deals anymore … Obamacare is a disaster -- I’ll take care of it.’ OK, well we’ll see today whether that’s true. At this point, it’s Trump versus a group of more than two dozen conservative lawmakers who have spent years stifling John Boehner and Paul Ryan. The GOP leadership is calling Trump ‘the closer’ -- a subtle nod to their belief that it’s his job to get this thing through. A loss here would throw that -- and Trump’s entire legislative agenda -- into question.

-- THE AGENDA. Republicans have talked about repealing Obamacare for nearly a decade. If they can’t get it done, how can we expect tax reform to get done? Forget the silly August deadline that the New York wing of Trump’s White House is peddling. If they can’t get health care done in the House, where the GOP enjoys a large majority, how can they rewrite the incredibly complex tax code?

-- DEMOCRATS are holding strong against the bill. House Minority Leader Nancy Pelosi (D-Calif.) can smell blood in the water. Expect to hear more about how Trumpcare will tax older Americans, provide less coverage and cost more. By the way, Pelosi dealt with similar dynamics in 2009 during Obamacare -- her liberals wanted a public health-insurance option. They promised to never vote for any bill without it. Over a few months, they systematically broke down.

-- SOMETHING TO REMEMBER -- The last time Republicans owned something big on health care was in 2003 with President George W. Bush’s Medicare prescription drug bill. GOP leadership had to basically lock the doors and hold open the vote for hours to flip three or four holdouts. The political dynamics were far different back then. The GOP had a strong whip in Tom Delay, and they had goodies to dole out, like earmarks.

-- THE REAL QUESTION. What is the Republican endgame here? They’ve made so many changes to the bill that nearly everyone concedes that, even if House Republicans pass it, it is basically dead on arrival in the Senate. It’s hard to remember a more consequential vote or issue where there wasn’t a long-term political strategy. Even if this somehow becomes law, it will almost certainly face issues in implementation. Republicans are coming up against the hard reality that voters want more health care for less cost, which is virtually impossible to deliver on.

THE LATEST -- “White House shift to right on health care angers moderates,” by Kyle Cheney, Rachael Bade and John Bresnahan. http://politi.co/2nfw99Q … “Inside Trump’s last-ditch bid to avoid a health care disaster,” by Rachael Bade, John Bresnahan and Kyle Cheney http://politi.co/2mTG1mh

--“Is Trumpcare already here?” by Politico Pulse author Dan Diamond: “No matter what happens to the Republicans’ troubled health bill in Congress, Trumpcare is here to stay. The Trump administration has already begun to transform the health insurance market, wielding executive power to rewrite coverage rules, slash Obamacare’s marketing budget and signal an all-out assault on his predecessor’s health care law. And Republicans have high expectations the administration will take additional measures to unwind Obamacare, such as targeting its contraception coverage requirement at the center of two recent religious liberty cases at the Supreme Court.” http://politi.co/2mXhxZR … Subscribe to Pulse http://politi.co/2mVjdWD

-- THE PAUL STREET JOURNAL: “Keeping Our Promise to Repeal ObamaCare: Our bill guts the failing law and enacts conservative reform without pulling the rug out from under anyone,” by Speaker Paul Ryan in the Wall Street Journal. http://on.wsj.com/2nMdlQV

WHAT DEMOCRATS ARE DOING -- The Democratic National Committee is launching robocalls to roughly 50 vulnerable Republican House districts this morning. The calls to constituents in those districts feature DNC Chair Tom Perez telling voters about the “disastrous bill and how it would affect people between the age of 50-65, urging them to contact Congress.”

-- AMERICAN BRIDGE -- the outside Democratic group -- is releasing a digital ad targeting disaffected Trump voters (including people who voted for President Barack Obama but also voted for Trump) with an emphasis on congressional districts with vulnerable Republican incumbents. The ad http://bit.ly/2na5nhm

THE TRUTH BOMB -- RICH LOWRY in Politico, “The Health Care Albatross”: “Republicans should get used to it. Their agony on health care is just beginning. For the past seven years, the party benefited from its powerlessness, which usefully maximized its ability to criticize Obamacare and minimized its responsibility to do anything about it. Now, with unified control of government, the party will pay the piper. Nothing good will come of the Obamacare repeal-and-replace debate. If anything resembling the current bill passes and is signed into law, Republicans will spend years trying to fix it and live it down. If the bill fails, the rest of President Donald Trump’s legislative agenda may sink with it.” http://politi.co/2nFNf1v

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