The Republican Party's seven-year quest to repeal Obamacare faces its ultimate test on Thursday, when the House votes on a bill that would dismantle the pillars of the Affordable Care Act and make sweeping changes to the nation's health care system.
Capping weeks of closed-door negotiations, arm-twisting and intra-party squabbling, Majority Leader Kevin McCarthy appeared triumphant Wednesday night as he emerged from Speaker Paul Ryan's office. He delivered news that had eluded President Donald Trump and House leaders for months: They finally have the votes.
"We will be voting on the health care votes tomorrow. Because we have enough votes," McCarthy, a California Republican, told a throng of reporters gathered outside. "It'll pass. It's a good bill."
The good mood radiated from across town, as well: White House Chief of Staff Reince Priebus told CNN Wednesday night that he was "optimistic" about the vote.
But as House leaders and White House officials projected confidence in public, their severe struggles over the past few months to garner the 216 votes needed to pass the bill in the House has cast a blanket of nervous energy over the party. Even in the hours leading up to McCarthy's announcement, Republican lawmakers were expressing deep reservations about the legislation.
A key GOP source close to the health care process grumbled Wednesday night that not everybody was feeling as confident as McCarthy, and that there were no guarantees that the bill would ultimately pass.
If Republicans remained divided on the merits of the legislation, by Wednesday they at least appeared to agree on one thing: It was time to move on from this health care bill, one way or the other.
"As the calendar ticks over another page or two, we either get something done or we live with Obamacare," GOP Rep. Steven King said before Thursday's vote was announced.
Until late Tuesday, the bill had appeared all but on the brink of collapse. But there was renewed momentum after GOP Reps. Fred Upton and Billy Long met with Trump at the White House and came out to announce that their "no" votes had become "yes."
They proposed an amendment that would add $8 billion over five years to fund high-risk pools and go toward patients with pre-existing conditions in states that seek waivers under the Republican legislation. The legislation already included $130 billion in the fund.
In a furious search for votes, leadership's focus in recent days has been almost entirely on moderate lawmakers concerned that the GOP bill will erode too many protections in the Affordable Care Act.
The $8 billion additional for high-risk pools -- while it signaled movement -- was not enough to win over plenty of other moderate Republicans, who said the amount simply wasn't enough to make a difference for patients with pre-existing conditions.
New Jersey Rep. Leonard Lance, a moderate Republican opposed to the bill, told CNN that Upton's proposed change would not sway him to support the health care legislation. Lance also noted that he has not heard from Trump or Pence in several weeks.
Moderate Republican Reps. Charlie Dent, Frank LoBiondo and Jaime Herrera Beutler also said they still oppose the bill even with the Upton amendment.
Others still had not made up their minds by Wednesday night. GOP Rep. Carlos Curbelo of Florida told CNN when reached by phone that he was out at a restaurant and still had not read the revised bill. Curbelo said he planned to "review it when I get back."
Democrats, for their part, are poised to hold the health care bill over the heads of Republicans in 2018.
As antsy reporters stood outside of Ryan's office Wednesday night, waiting for guidance on whether there would be a vote Thursday morning, Democratic Rep. Elijah Cummings approached the group to joke that he had a "breaking" announcement.
Republicans had the votes on their health care bill, Cummings said. His punchline: And Democrats will take back the House in 2018.
As originally introduced, the GOP bill would leave 24 million fewer people insured by 2026 than under Obamacare, the non-partisan Congressional Budget Office said. There will not be a new CBO report before Thursday's vote on the legislation.
House Minority Leader Nancy Pelosi blasted the bill and decision to vote Thursday.
"Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan to push Americans with pre-existing conditions into the cold," Pelosi said in a statement. "But tomorrow, House Republicans are going to tattoo this moral monstrosity to their foreheads, and the American people will hold them accountable."
What's in the bill?
The GOP health care bill would eliminate Obamacare taxes on the wealthy, insurers and others, and get rid of the individual mandate imposed by Obamacare, officially known as the Affordable Care Act. Instead of the Obamacare subsidies that are tied to income and premiums, the GOP plan would provide Americans with refundable tax credits based mainly on age to purchase health insurance.
The legislation would also allow insurers to charge higher premiums to those in their 50s and early 60s, compared to younger consumers.
It would also significantly curtail federal support for Medicaid and allow states to require able-bodied adults to work. After 2020, states that expanded Medicaid would no longer receive enhanced federal funding to cover low-income adults, and those that hadn't expanded would be immediately barred from doing so.
And it would allow states to relax some key Obamacare protections of those with pre-existing conditions, which are among the health reform law's most popular provisions. States could apply for waivers to allow insurers to offer skimpier policies that don't cover the 10 essential health benefits mandated by Obamacare. Also, insurers would be able to charge higher premiums to those with medical issues if they let their coverage lapse. States requesting waivers would have to set up programs -- such as high-risk pools -- to protect insurers from high-cost patients.
However, the GOP bill doesn't touch one another beloved piece of Obamacare -- letting children stay on their parents' insurance plans until the age of 26.
