Trump, Republicans to roll the dice with Friday health care vote

Determined to push a health overhaul bill through the House, President Donald Trump is basically daring GOP lawmakers to vote against the plan, as Republican leaders in Congress unveiled several new changes to the bill on Thursday night, hoping they would bring conservatives and moderates on board to avoid what would be an embarrassing political defeat on the politically explosive issue of health care.

Here is the latest from Capitol Hill:

1. White House decides it is simply time to vote. Looking to avoid a never-ending parade of negotiations that might not bear fruit, President Trump had his lieutenants go to Capitol Hill to send a message to GOP lawmakers at a closed door meeting - it's time to vote on a GOP health bill that's been the subject of intense talks in recent days. "It's a call to unity," said Trump's chief ally in the House, Rep. Chris Collins (R-NY). "The President said there will be a vote...we're then going to move on to the rest of his agenda." In other words - if Republicans defeat this bill, then you get to live with Obamacare. It will put pressure on GOP lawmakers to get in line.

2. What is being changed in the bill? After a lot of negotiating in recent days, the GOP unveiled several changes, the main one being a plan to get rid of federally required, "Essential Health Benefits" in the Obama health law. That is basically what sets out the minimum requirements for what a health insurance plan must cover. The idea there is by getting the federal government out of that type of regulation, it can help reduce premiums, by allowing insurance companies to offer less expensive plans - which would not cover as much in terms of possible health issues. "Each State shall define the essential health benefits," is what the text says. That move will cost the GOP some moderate votes.

3. One Obamacare tax will survive for six years. While Republicans have talked about getting rid of all the taxes from the Obama health law, this latest GOP revision would keep a 0.9 percent surtax on high income earners for Medicare to 2023, with that money being funneled into a $15 billion "stability fund" to help deal with coverage for mental health, maternity coverage and newborn care. That seems to be the only tax from the health law that would survive in the GOP plan, other than a longer term delay in the implementation of the Cadillac tax on higher cost health plans, which wouldn't be implemented until 2026.

4. Some GOP lawmakers still holding out for more changes. As the House wrapped up work on Thursday night, Speaker Paul Ryan could be seen on the House floor in an extended discussion with Rep. Dan Webster (R-FL). I knew exactly what that was about. Webster has been telling me for weeks that one issue he wants addressed in this bill that impacts his home state of Florida, is to make sure there is enough money available in Medicaid to fund nursing home beds in the Sunshine State. "They're going to work on it, see if they can get to what I want to do," Webster told me Thursday night. "We'll see what happens." It wasn't in the amendment that was filed with the Rules Committee.

5. Other Republicans not sure what they would do. As I chased down GOP lawmakers during the final series of votes on Thursday night, several gave me the look of, "Don't ask me about health care" as I approached, not yet ready to say what they would do on Friday. "We'll have to see what bill they intend to put on the floor," said Rep. Mike Turner (R-OH). "I'm still a 'no,'" said Rep. Ted Yoho (R-FL), though he immediately noted that the tide seemed to be turning in favor of the health care bill. "Keeping my fingers crossed," said Rep. Steve Stivers (R-OH) as many Republicans say it's time to pass the bill and move on.

6. But what if it collapses on the House floor? There were some who wondered if President Trump was bluffing, trying to buffalo Republicans into thinking that the bill will pass, in order to get them on board. A defeat would certainly ripple through the halls of Congress and down at the White House, and already on Thursday evening, the knives seemed to be out for Speaker Ryan. Usually you don't roll the dice or bluff in a legislative session, but there seemed to be a bit of that going on, as the President dares the Freedom Caucus and others to vote no.

7. Arrows also pointed at the Freedom Caucus. While some wonder what might happen to Speaker Ryan if the health bill goes down to defeat, there are other Republicans who feel like the House Freedom Caucus needs to get in line. "This is a team exercise," said Rep. Tom Cole (R-OK). We can't have a small group - left or right - dictating to everybody." One person getting some flak was the Freedom Caucus chair, Rep. Mark Meadows (R-NC). "Mark Meadows is more interested in being on the TV than solving problems," fumed Rep. Austin Scott (R-GA).

8. Will the bill win? Will it lose? I don't like to make predictions. If you think Trump is just bluffing, you could find ample evidence that last minute wrangling wasn't moving votes his way on health care. "I'm a no," said Rep. Leonard Lance (R-NJ), who rejected the move to strip the Essential Health Benefits. "I do not like that change." Some Freedom Caucus members were still not on board, like Rep. Thomas Massie (R-KY), who said he was voting, "HELL NO." There is a lot at stake in the political fight over the Obama health law.

The House Rules Committee convenes at 7 am on Friday. The House convenes at 9 am. A vote on the GOP health bill could take place by late in the afternoon.

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