March 23 (UPI) -- Fractured support among conservative Republicans hampered the GOP plan to repeal and replace the Affordable Care Act on Thursday -- and led President Donald Trump to make a substantial gamble with his healthcare policy by demanding one final showdown in the House.
Earlier, lawmakers postponed a scheduled House vote on the GOP-crafted American Health Care Act after multiple 11th-hour meetings aimed at brokering a compromise with hesitant conservatives failed to produce a resolution.
The delay was announced after more than 30 conservative House lawmakers visited the White House hoping to get on board with the AHCA by hashing out their concerns with the president. It didn't work.
"Nothing new was agreed upon," Rep. Paul Gosar, R-Ariz., said, adding that the group of unpledged lawmakers were left to return to the Capitol and consider their options.
Late Thursday, Republican leaders abruptly announced that the bill's vote had been set for Friday afternoon -- even though they still may not have enough support to get it passed.
The decision to go forward Friday came at Trump's insistence, after the president and House Speaker Paul Ryan essentially told GOP voters to take the new plan as is, or leave it, White House Budget Director Mick Mulvaney said.
If the vote fails, Trump purportedly said he will leave the Affordable Care Act in place and move on to other matters. Rep. Chris Collins, R-N.Y., and Mulvaney both said Trump is done negotiating on healthcare.
The president's demand for a vote Friday is a risky proposition. If the AHCA fails, it would be an embarrassment for Trump and House Republicans, which could undermine other items on their agenda.
Earlier Thursday evening, Trump and Vice President Mike Pence met with the conservative Tuesday Group, and expressed optimism they are working toward a solution.
"We're making strong progress," Pence tweeted.
Democrats have dismissed the plan because it rolls back Medicaid expansion and provides tax cuts for the wealthy. They also cite a report by the Congressional Budget Office that says some 24 million people will be uninsured within 10 years and premiums will increase in the short term.
Conservatives have panned the package because they say it doesn't go far enough in repealing former President Barack Obama's law, often called Obamacare.
Republicans have worked fervently this week to polish the proposal to keep it from falling apart. Ryan has previously "guaranteed" that the bill will pass the lower chamber.
In order to be approved and sent to the Senate, the AHCA needs 215 of the 237 Republican votes in the House. As of mid-Thursday, whip counts indicated the GOP could be well shy of that threshold -- as about 30 of the party's lawmakers were still uncertain about supporting the plan.
In other words, House Republicans can only afford to lose 21 votes. The bloc of Freedom Caucus voters could easily surpass that threshold by themselves. There will be no more negotiating, lawmakers said, which means the conservative group must now decide whether they will accept or reject what is effectively Republican leaders' final offer.
Obama, who has not made many public statements since he left office January 20, chimed in the debate on Thursday.
"If Republicans are serious about lowering costs while expanding coverage to those who need it, and if they're prepared to work with Democrats and objective evaluators in finding solutions that accomplish those goals -- that's something we all should welcome," he said in an email. "But we should start from the baseline that any changes will make our health care system better, not worse for hard-working Americans."
If the bill is passed Friday and advances to the Senate, where its fate is even less certain, 51 out of the 52 Republican lawmakers there would need to approve it.
The vote was originally supposed to occur Thursday, on the 7th anniversary of the ACA's passage -- a fact some found coincidental, and others intentional.
"We must repeal AND replace Obamacare for the millions that are suffering," Trump tweeted Thursday. "Tell your Rep you support AHCA."
"You were given many lies [with Obamacare]. Go with our plan," Trump said in a video message.
"You do not bring up your bill just to be spiteful to the anniversary of the Affordable Care Act," House Minority Leader Nancy Pelosi, perhaps the Democrats' most outspoken AHCA opponent in the lower chamber, responded. "You build your consensus in your party -- and in the Congress, hopefully -- and then you bring up the bill.
"Rookie's error, Donald Trump. You may be a great negotiator; rookie's error for bringing this up on a day you clearly are not ready."
Pelosi also took aim at GOP leaders for talking about subtracting maternity coverage as part of their healthcare plan.
"This is outrageous: Not a single woman in the room as [VP] Mike_Pence and House Republicans propose removing maternity coverage in Trumpcare," he tweeted with a photo from the meeting.
The chairman of the Freedom Caucus, North Carolina Rep. Mark Meadows, said his main objection is that the AHCA does not lower premiums for most Americans.
Many caucus members have been courted heavily by Trump, who visited Capitol Hill earlier this week to persuade the House to pass the AHCA. The president warned GOP lawmakers they might eventually lose control of Congress if they don't approve the bill.
Earlier this month, the Congressional Budget Office put off some lawmakers with a report that said the AHCA would result in 24 million fewer insured Americans over the next decade -- citizens the ACA would have covered.
The GOP plan shares some similarities with the ACA, like requiring insurers to cover people with pre-existing conditions and providing coverage subsidies. Young adults would also be allowed to remain on their parents' insurance until the age of 26.
Unlike the former president's signature law, though, the AHCA would spend less on subsidies and reduce Medicaid spending -- using those savings to eliminate taxes imposed by the ACA on wealthier Americans and medical companies.
The CBO report also projected that the Republican plan would reduce the federal deficit by $337 billion -- a figure the office revised Thursday to $151 billion after a re-analysis to account for changes Republicans made to the bill Monday.
In an effort to win over resisting conservatives, GOP leadership made the changes to grant individual states more flexibility on Medicaid, and eliminate ACA taxes for uninsured persons this year instead of the original 2018 target date.
To please moderates, the revisions also said Medicaid allotments for older and disabled beneficiaries would increase faster than inflation, and allowed the Senate to craft more generous tax credits for people between the ages of 50 and 64.