Trump, House leaders, conservatives working on health care deal

Republicans can afford only 21 defections in the House, if no Democrat joins them
So far, 23 House GOPers have flat-out said they will vote against the bill
"There's a certain amount of gamesmanship going on here -- a little bit of chicken"

Washington (CNN)President Donald Trump is personally calling individual members of the influential conservative House Freedom Caucus Wednesday evening as House leaders work on a possible deal to secure the votes to pass the GOP health care bill.

Which Republicans are opposing the Obamacare repeal bill?

Which Republicans are opposing the Obamacare repeal bill?

After a frenzied day of private huddles and hushed conversations at the White House and across Capitol Hill, leaders are now considering including a provision to strip Obamacare's essential health benefits as part of their repeal bill to be voted on Thursday, a House leadership aide tells CNN.

What's inside the Republican health care bill?

The vote count is tight. According to CNN's ongoing whip count as of Wednesday afternoon, 23 House Republicans have flat-out said they will vote against the bill, while four more have indicated they are likely to oppose it.

This would be a major shift that could attract enough conservatives to back the bill.

Freedom Caucus Chairman Mark Meadows was suddenly optimistic.

Will Trump cut back mandatory maternity or mental health coverage to save GOP bill?

Will Trump cut back mandatory maternity or mental health coverage to save GOP bill?

"Meadows is working with the President and his team around the clock to make changes to the bill. We're hopeful we can get something done," the congressman's spokesman told CNN, marking a stark departure from previous days when a stream of meetings and even direct talks with the president had led to no progress.

One aide said the new sense of cautious optimism had not existed among Freedom Caucus members even an hour prior, and that the group's members planned to work late into the night.

Getting conservatives to back the bill is essential because moderates are jumping ship. A handful of relatively moderate Republicans hailing from New York, Iowa and New Jersey said Wednesday they would not support the bill. One lawmaker even stated bluntly that the GOP plan simply was not better than Obamacare.

Bleeding support from moderates makes the challenge for House Speaker Paul Ryan and his allies much more complicated -- and affirms that one concession or deal is unlikely to appease members across the political spectrum.

Trump and Ryan must get 216 Republicans on board and can afford only 21 defections, if no Democrat joins them.

Trump has been meeting with lawmakers at the White House to press for votes, but shied away from a public display of confidence. Asked by a reporter if he plans to keep trying on health care if the House bill fails, the President simply said: "We'll see what happens."

"There's a certain amount of gamesmanship going on here -- a little bit of chicken," GOP Rep. Tom Cole told CNN.

Trump has warned of big losses at the ballot box if Republicans fail to repeal and replace Obamacare, and the White House insists there is no alternative legislation or plan if they fail.

Trust in Trump being tested

"There is no Plan B. There's Plan A and Plan A," said White House press secretary Sean Spicer. "We're going to get this done."

"This is an all-hands-on deck situation," a senior House GOP aide said Tuesday.

Various lawmakers who are planning to vote "no" have described to CNN having 30-to-45 minute phone calls with Trump officials in the past 36 hours. And Vice President Mike Pence and Health and Human Services Secretary Tom Price are also involved in behind-the-scenes lobbying.

Ryan's whip operation is in full blitz mode. The House speaker has been texting directly with some members. Majority Whip Steve Scalise and Deputy Whip Patrick McHenry have also been singling out individual Freedom Caucus members to try to peel them away from the group.

According to Republican Rep. Richard Hudson, who supports the bill, Trump agreed to GOP Rep. Steve King's request to lobby to change the essential health benefits at a later point. At a meeting at the White House Wednesday, Trump told King he would publicly push for the change in the Senate and King agreed to vote for the bill.

"They shook hands," Hudson told reporters. "We are voting tomorrow, no matter what, but I feel like we'll have the votes."

Separately, GOP Rep. Lou Barletta announced Wednesday that he had switched his "no" vote to "yes" after receiving support for his legislation to deny health care credits to illegal immigrants.

Where's the Freedom Caucus?

Earlier in the day, still stubbornly opposed to the health care proposal were some members of the conservative Freedom Caucus. According to a source, the caucus' members have been invited to visit the White House in small groups in recent days.

That effort continued Wednesday, with the group's members again paying a visit to 1600 Pennsylvania Ave.

But afterward, Meadows said he remains a "no" vote, and a Freedom Caucus source insisted that the group still counted enough "no" votes to sink the bill.

Meadows said Pence "put some things on the table" but that "there have been no official offers."

A Freedom Caucus spokesperson said the group had more than 25 "no" votes as of Wednesday afternoon, but declined to provide names to reporters.

Wednesday also brings the last official procedural stepping-stone before the bill heads to the House floor -- the Rules Committee, a panel traditionally full of leadership loyalists, which should clear the way to consider amendments to the measure and set up Thursday's dramatic vote.

That's an important step, but it's the arm-twisting that happens in closed-door meetings that will make the difference.

Trump met with some members of the moderate Republican "Tuesday Group" on Tuesday, and for one of those members, face time with the president wasn't enough to sway him.

"I'm a no," GOP Rep. Leonard Lance told reporters after returning from a meeting with Pence.

Lance, who Democrats view as vulnerable in 2018, said he was still hung up on the fear that his older constituents would have to shoulder higher coverage costs under the Republican bill. "I indicated to the President my concerns in several areas," Lance said, as he suggested that the chance to make further changes to the legislation was closed.

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Another New Jersey Republican came out against the bill Wednesday: Rep. Frank LoBiondo. He said he was concerned about the bill's impact on his state's residents and that the proposal "is not as good as or better than what we currently have."

What's in the bill

The bill introduced earlier this month would roll back many of the Obamacare taxes and eradicate the individual mandate. Instead of the subsidies available in the Affordable Care Act, the GOP plan provides Americans with refundable tax credits to purchase health insurance.

The bill also significantly restructures Medicaid and allows states to require able bodied adults to work if they want to be eligible for the program. After 2020, states will no longer be able to expand Medicaid like they could under Obamacare and states that haven't expanded the program at all are barred from doing so.

The GOP bill, however, still includes some of the most popular pieces of Obamacare, including protections for people with pre-existing conditions (though insurers would be allowed to charge higher premiums to individuals whose coverage has lapsed) and letting children stay on their parents' insurance plans until the age of 26.

The non-partisan Congressional Budget Office estimated that 24 million fewer Americans would be covered under this bill than under Obamacare by 2026 if the bill is enacted in its current form.