Rep. Pete Sessions, R-Texas (Photo: House)

(Bloomberg) — House Republicans are facing intense pressure from the White House to vote on their stalled Affordable Care Act change effort this week, but party leaders still don’t know whether they have the votes to pass the American Health Care Act bill.

Conservative and moderate holdouts are still “struggling to get to yes,” said Rep. Tom MacArthur of New Jersey, the chief author of an amendment that is reviving hopes for the AHCA bill.

“I think it’s close,” said MacArthur on whether enough votes to pass the bill will be found. “But I think there is a real chance of a vote.”

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But several moderate Republicans are visibly frustrated about the renewed push to pass the bill after leaders made changes aimed at winning over conservatives.

“We’ve been through this before,” Republican Rep. Charlie Dent of Pennsylvania said Thursday. “The business model around here is to load the bill up, make it as conservative as possible, send it to the Senate and have the Senate clean it up and send it back, and the very people who are placated on the first launch won’t be there on the final. And that dog ain’t hunting anymore.”

House Rules Chairman Pete Sessions, a Texas Republican, added that he hasn’t seen “any impact” from the amendment on the bill’s prospects.

The Republican vote-counting team is trying to gauge support for a vote Saturday, according to a Republican aide familiar with the process. Some lawmakers are pushing for a quick vote even as industry groups are starting to weigh in with criticism of the revised measure.

House leaders have put the bill on this week’s House floor calendar.

House Speaker Paul Ryan told reporters Thursday that there has been “real progress” in winning over skeptics. “We have not yet made any decisions on a vote,” he said.

White House Press Secretary Sean Spicer told reporters that President Donald Trump “wants a vote when they have 216 votes, and I feel very good about the progress that’s being made to get to that number.”

The text of the bill and a pair of amendments were posted late Wednesday on a website listing bills that may be considered this week on the House floor, but the House Rules Committee hasn’t yet scheduled a meeting that would be needed to prepare for a floor vote.

100th Day

Saturday would mark Trump’s 100th day in office, although that milestone is more important to the White House than to House leadership, the Republican aide said.

“I’m still holding out for Saturday,” Trump’s budget director, Mick Mulvaney, said Thursday morning on CNBC.

Other undecided Republicans “are so close to yes that I’m very optimistic whether the vote is tomorrow or Saturday or next week, the votes will be there to actually pass this,” House Freedom Caucus Chairman Mark Meadows said Thursday on Bloomberg TV. He said later Thursday that they don’t yet have enough votes to pass the bill.

The most recent changes to the bill have won the formal backing of the conservative Freedom Caucus, but some moderates remain opposed. A Bloomberg News count shows at least 16 Republicans opposed to the revised measure. The GOP can only afford to lose 22 votes from its side and still guarantee passage.

The Congressional Budget Office has also told Democrats that it won’t have an updated estimate of the cost of the revised measure or how it would affect insurance coverage this week or next week, according to a tweet from Drew Hammill, deputy chief of staff for House Minority Leader Nancy Pelosi.

The American Medical Association, American Hospital Association and AARP, the lobbying group for senior citizens, said they oppose the revised Obamacare measure.

“The proposed change would still result in millions of Americans losing their health care coverage and could make coverage unaffordable for people with pre-existing conditions,” the AMA said in a statement.

The hospital group said allowing states to get waivers from a requirement that insurers cover so-called essential health benefits “could leave patients without access to critical health services and increase out-of-pocket spending.”

State ‘Flexibility’

MacArthur, who defines himself as a centrist, disputed criticism that his amendment would be a setback on coverage for people with pre-existing conditions.

“What my amendment does, first and foremost, is it protects people with pre-existing conditions, while at the same time giving states some flexibility so that they can bring costs down,” he said.

MacArthur brushed off criticisms from fellow moderates that his amendment is designed to draw conservative support at the expense of centrists’ concerns. Dent, the senior leader of a bloc of House centrists, said Wednesday the amendment is “an exercise in blame-shifting” onto moderates, should the bill fail.

“I don’t think in those terms, at all,” said MacArthur. “We either win together, or we all lose.”

Ryan also said that Republicans need to deliver on their seven years of promises to repeal the Affordable Care Act.

“I think people’s seats are at risk if we don’t do what we said we’d do,” he said when asked about political risk to moderates voting for the bill. “If you commit the sin of hypocrisy in politics” that’s a bigger risk to losing an election, Ryan said.

—With assistance from Greg Sullivan, Arit John and Sahil Kapur.

— Read White House Still Pressing to Hold ACA Change Vote This Week on ThinkAdvisor.

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