Trump Faces Most Consequential Day Of His Presidency So Far

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Throughout the campaign, President Trump billed himself as a master negotiator who would make the "best deals" for the American people.

That reputation and the reach of the president's bully pulpit face a tough test Friday after he gave House Republicans an ultimatum to vote to repeal and replace the Affordable Care Act — or leave Obamacare in place.

A vote is now expected sometime Friday afternoon, though the GOP plan known as the American Health Care Act still remains in limbo as members on both the right and the center of the Republican caucus find parts of it difficult to stomach.

After a caucus meeting late Thursday, however, there were signs the stalemate was beginning to thaw. Some members suggested that the White House's ultimatum might have pushed some legislators to realize that this is perhaps their make-or-break moment to fulfill a campaign promise they've long been running on.

"In politics there is always another day, but there are certain critical moments where things come to a head, and I think tomorrow is one of those moments, one of those test moments for this conference," Rep. Tom Cole, R-Okla., said after House Republicans met Thursday night. "I hope we're up to it."

House Debate Of GOP Health Bill Is Underway PBS NewsHour via YouTube

"It's one thing to be in the fight and try to score a touchdown, but sometimes on the fourth down, you kick the field goal," said Rep. Joe Barton, R-Texas. "It's a good bill and we should vote for it."

The looming showdown follows a tumultuous day that saw a long-promised vote on the Republican alternative bill — originally slated for the seventh anniversary of Obamacare's signing — hurriedly postponed after it became clear there weren't enough votes to pass it.

GOP leaders and the Trump White House have been wooing the ideological opposite ends of the House Republican caucus to try to salvage a deal. But the attempts to meet the demands of the conservative House Freedom Caucus — who are under pressure from conservative interest groups not to bend — and the most moderate members of the Tuesday Group — who could face electoral backlash in 2018 in their swing districts — were often at odds.

Freedom Caucus members were signaling late Thursday night that some of their demands were being met. An amendment released after the GOP meeting would repeal essential health benefits and let states set their own standards for that part of health insurance coverage for individuals purchasing coverage with a tax credit. It would also provide additional money for a fund for mental health and substance abuse disorders and maternity care.

But some of those concessions — namely the repeal of essential health benefits in Obamacare — could also be nonstarters with more centrist Republicans.

"I do not think that it lowers premiums and I do not think that it covers enough people," Rep. Leonard Lance, R-N.J., told NPR's Kelly McEvers on All Things Considered Thursday before the conference meeting. Lance represents one of 23 GOP-held districts that Trump did not carry last November and is expected to be a top Democratic target in 2018.

Trump has lobbied members on the bill but has seemed reluctant to put his full political weight behind the issue and at times appeared daunted by the task before him. "Nobody knew that health care could be so complicated," the president bemoaned last month, an incredulous statement to anyone who knows how intricate and nuanced health care policy really is.

He has hit the campaign trail with full-fledged campaign rallies to try to generate support for the bill, but at his appearance this week in Louisville, Ky., Trump barely even touched on the subject.

And, perhaps most telling, for a man who loves putting his name on everything from skyscrapers to steaks, he has eschewed the moniker "Trumpcare" for the GOP's effort to repeal and replace the Affordable Care Act.

House Speaker Paul Ryan also has a lot of political capital riding on the outcome of Friday's vote. He has tried to work with a president he withdrew support from during the campaign, but if the vote fails it could destroy the already fragile relationship between the two and ignite a blame game between the White House and GOP congressional leaders. There were already signs that was beginning to happen Thursday night, with the New York Times reporting that Trump has told his aides he regrets going along with Ryan's push to overhaul health care before tackling tax cuts and other legislative issues.

The frustration and exhaustion of the political brinkmanship pushed almost entirely by the White House was evident on Ryan's face as he emerged from the Republican conference meeting Thursday evening. He didn't take any questions from reporters and simply spouted off a terse statement: "For 7 1/2 years we have been promising the American people that we will repeal and replace this broken law because it's collapsing and it's failing families. And tomorrow we're proceeding."

Ultimately, the House vote could be an exercise in legislative futility. If the bill does pass, it will be changed in the Senate, where it also faces an uphill battle. And this is just Part 1 of the three-part plan by Republicans to overhaul and replace Obamacare.

But if the first bill dies in the House, the broader message could be devastating for both Trump and House Republicans. The failure would signal that they haven't yet found a way to govern in Washington despite finally holding both the White House and control of Congress. The setback would spell doom for many of Trump's other priorities, including tax reform, and exacerbate what's already been a bad week for the White House, which began with FBI Director James Comey confirming to Congress that the agency is investigating possible ties between the Trump campaign and the Russian government.

In many ways, Republicans have backed themselves into a no-win situation. If they rush to pass an unpopular bill riddled with problems, they're giving Democrats plenty of ammunition to use in the midterm elections, and GOP members on defense at town halls over health care could be further put on their heels. But if the bill fails, the discord and disarray in the GOP overshadowed by Trump's unlikely win last November will only be magnified, and this could be just the beginning of headaches for Republicans at both ends of Pennsylvania Avenue.

NPR's Barbara Sprunt contributed to this report.