House Republicans can only lose 22 votes and still pass the bill. | AP Photo Outlook for Obamacare repeal turns bleak But House Republicans and the White House stepped up their efforts to win passage.

A sense of gloom settled over House Republicans on Tuesday as support for their Obamacare repeal plan seemed to erode even further and members began reckoning with the unthinkable: They may never be able to repeal Obamacare.

But House GOP leaders and the White House kicked into high gear Tuesday night in a last-ditch effort to save the bill.


Speaker Paul Ryan and his team began crafting an amendment aimed at assuaging moderates' concerns about how the bill treats people with pre-existing conditions. The language, multiple sources say, is expected to be released Wednesday.

President Donald Trump, meanwhile, is personally wading in to save the bill, calling members who oppose the legislation to help whip support, two sources told POLITICO. Trump will also huddle with opponents of the bill at the White House Wednesday, the sources said. And insiders are crossing their fingers that he can flip enough to "yes" to push the bill over the finish line.

Discussions of a new amendment followed a disheartening day for House Republicans. Rank-and-file members increasingly acknowledged the difficult path to passage for their long-stalled bill, the American Health Care Act.

Their pessimism stemmed from the defection of a key leadership ally, Rep. Fred Upton. The Michigan Republican, who once authored a slew of Obamacare repeal measures, said the latest GOP proposal failed to protect people with preexisting conditions.

House Freedom Caucus Chairman Mark Meadows (R-N.C.), who helped broker the latest version of the AHCA, said Upton’s departure could be a significant blow to the cause.

“Obviously that’s not a move in the right direction,” Meadows said.

Rep. Chris Collins (R-N.Y.) described the recent loss of support as “disappointing” and said he’s worried about the House Republican health care effort. Collins even suggested scrapping the latest version of the plan — the result of painstaking negotiations between House conservatives and a top moderate — and reverting to an earlier iteration of the bill that had more support from centrists.

"Then leadership can go work on getting the votes,” Collins said.

Yet that move would certainly lose conservative votes, and put Speaker Paul Ryan (R-Wis.) and President Donald Trump even further away from their goal. Neither man can afford a loss right now, especially Ryan, who is already under pressure from hardline conservative media outlets over his stewardship of the House.

White House officials and GOP leaders on Tuesday night seemed hopeful that additional "tweaks" to the bill could win new supporters. Trump officials are pushing for a vote on the health care bill before House Republicans break for a one-week recess Thursday.

All day, House leaders struggled to shake the hardening narrative that sicker Americans would suffer under their plan. Ryan argued to lawmakers in a closed-door GOP conference meeting that people with pre-existing conditions would not be harmed by the latest draft. Vice President Mike Pence and Health and Human Services Secretary Tom Price spent the afternoon huddling with lawmakers attempting to tamp down their concerns.

House leaders even began floating the notion of piling billions of additional dollars into a fund meant to cover costs for people with preexisting conditions in an attempt to woo back reluctant moderate Republicans. It is unclear if the changes might win over skeptics like Upton and Long. It's also unclear whether the Freedom Caucus, which currently backs the bill, would approve.

Rep. Phil Roe (R-Tenn.), a member of the whip team, is optimistic the remaining undecideds and some opponents can be brought on board. But he admits the bill might have to be changed.

“It’s about seeing… what they can get comfortable with on preexisting conditions,” Roe said. “I’ve got one more idea I’m going to shop with them today,” he said, but refused to share details.

Rep. Tom Cole (R-Okla.) said leaders would likely “throw every sink in every kitchen they can find” to win last-minute support for the bill. But Cole said the most persuasive argument may be the most basic.

“If you kill it in the cradle, you’re basically ratifying Obamacare,” he said.

About 20 GOP lawmakers — mostly moderate or centrist Republicans worried about sicker Americans paying more for premiums – have now added their names to the “no” column. At the same time, the list of Republicans who say they’re “undecided” has grown to at least two-dozen. Even several GOP whips tasked with drumming up support for the bill said Monday night they have not yet made up their minds on whether to support the revised American Health Care Act.

Without any Democratic support, House leaders can only lose 22 votes in their 238-member caucus to pass the bill.

Republicans are planning a Thursday members-only meeting to discuss the repeal effort. While top Republicans insist Ryan's leadership team is close to reaching the 216-vote threshold needed for passage, their job is becoming tougher by the day, as more lawmakers publicize their opposition to the latest version of the bill.

Privately, GOP leaders and the White House appear to have had some individual successes convincing opponents of the measure to come back into the fold. Rep. Paul Gosar said he recently became a supporter after Trump and Pence promised the Senate would vote on an anti-trust bill he authored for the insurance industry.

"I got assurance that my Competitive Health Insurance bill that passed the House 416 to 7 will get a vote on the Senate floor," Gosar said. "It was one of my assurances working with the vice president and the president, the majority leader... Ryan is on board as well."

Publicly, GOP leaders are projecting an upbeat message. House Majority Leader Kevin McCarthy (R-Calif.) said Monday night that “I actually feel we’re in a very good place.” Chief Deputy Whip Patrick McHenry (R-N.C.) said “I think we’ll pass the bill” as he walked into the GOP conference meeting on Tuesday morning.

Leaders are also reminding members that, under the bill, insurance companies could only charge people with pre-existing conditions more if they have a gap in coverage. If they remain on insurance, they cannot be charged more than a healthy person.

"Our bill protects people with pre-existing conditions, and actually provides multiple layers of protections for people with pre-existing conditions in ways that Obamacare doesn't do," argued Majority Whip Steve Scalise in a press conference Tuesday morning.

On Tuesday, Trump, addressing members of the U.S. Air Force Academy at the White House, greeted several lawmakers in the crowd before prodding them to get health care legislation done.

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“How’s health care coming folks?” he said to an audience that included Reps. Martha McSally (R-Ariz.), Doug Collins (R-Ga.), Rep. Doug Lamborn (R-Colo.), Rep. Ted Poe (R-Texas) and Rep. Don Bacon (R-Neb.). “How are we doing? We moving along? I think it’s time now.”

Leadership is operating under a severe time crunch. The House is scheduled to break for a one-week recess starting Thursday, and Republicans fret that they could lose even more momentum during the break. Some are talking about canceling the recess, though GOP leaders have not yet decided how to proceed.

“If we don’t get a ‘yes’ vote this week, then what happens realistically? We’re taking flack back in the districts for not voting for a repeal,” said Rep. Dave Brat (R-Va.). “What is the response? The response is: 'Well, if we block this again, then you’ll get a scenario like the budget vote, where we go out and get Democratic votes to pass the health care bill, and that is a worse outcome!'... If you don’t get this policy passed, you end up with a Democratic bill.”

Meadows, too, said getting the AHCA done this week would be crucial.

“There comes a point in time where you say, either we continue to move forward with this foundational piece of legislation or you come back and regroup and find another piece of legislation that potentially could bring more people together.”

The White House, too, senses trouble for their health care push.

One senior White House official said "it's probably a toss-up right now" as to whether the plan passes the House this week, although other administration officials thought they had picked up some votes.

Josh Dawsey and Jennifer Haberkorn contributed to this report.