Still fewer than five days old, the House Republican bill to repeal Obamacare has an uncertain legislative path ahead. And no small part of the blame goes to President Donald Trump.
Competing interests among Republicans threaten to derail the party's urgent mission of gutting the Affordable Care Act. After publicly endorsing the bill developed by House Speaker Paul Ryan and other GOP leaders, Trump and some of his top officials held a flurry of closed-door meetings this week with critics of the legislation to try to move lawmakers toward a consensus.
But in these private gatherings, Trump appears to be sending some conflicting messages.
After sessions with leaders of influential conservative groups and lawmakers, administration officials signaled that the President was open to scrapping Obamacare's Medicaid expansion sooner than 2020 --- the date that is stated in the House GOP bill --- a change that could scare away moderate Republicans.
The confusion over the Medicaid portion of the Obamacare bill appears to be another example of Trump's eagerness to strike deals and negotiate -- and how that tendency can sometimes complicate things for members of his own party.
House conservatives openly acknowledge that they are seizing Trump's reputation as a dealmaker to try to reshape the health care overhaul.
"I like that about this president. He understands that no product is the final product," Idaho Republican Rep. Raul Labrador said Friday.
Just the development that the White House is publicly entertaining the change sent House GOP leaders scrambling to answer questions about whether the White House and congressional leaders see eye-to-eye on a major component of the health care bill.
"I think right now that would be very difficult to do," House Majority Leader Kevin McCarthy told reporters in a news conference Friday morning when asked if he supported moving up the sunset of Medicaid expansion.
Later in the day, White House press secretary Sean Spicer sided with House GOP leaders, saying: "Right now, the date that's in the bill is what the President supports."
Next week could bring more tumult -- the Congressional Budget office is expected to release its score of the House health care bill, which could show that millions will lose their coverage. The anticipated bad news is poised to be one more area where Trump could veer from the party message.
The Medicaid section in the House Republicans' Obamacare repeal bill was carefully crafted and congressional leaders warn that disrupting it now could imperil the bill. Scrapping the expansion earlier could help win over a handful of conservative votes, but it could cost GOP votes in the Senate where nearly 20 lawmakers hail from expansion states.
"The needle that leadership is trying to thread right now is exactly that between people who want to take things out of the bill and make it less than it is and those of us who are already struggling with the effectiveness on the most vulnerable," said Rep. Tom MacArthur, a New Jersey Republican who is a co-chair of the House's moderate Tuesday Group.
How to tackle the federal Medicaid expansion has emerged as one of the toughest obstacles for Republican leaders. Some 31 states -- including 16 with Republican governors -- took advantage of the program and found it to be a successful tool to insure low-income adults at little cost to their states.
The politics of Medicaid expansion has scrambled traditional political fault lines. It's not just a simple break between moderates and conservatives -- the differences of opinion are also between expansion and non-expansion state lawmakers.
Those from expansion states have worked closely with leadership to try to protect their federal match dollars for as long as possible while those from non-expansion states have argue the Medicaid expansion should sunset as soon as possible.
Bowling for votes
In recent days, senior administration officials have wooed conservative lawmakers in private meetings and even at a bowling party at the White House -- all as the administration has continued to publicly back the bill crafted by Ryan and committee chairs.
But GOP leadership aides caution that while they could still make some changes in order to get additional support before the final House vote, they don't anticipate the kinds of wholesale changes that House Freedom Caucus members are demanding.
If Trump has veered off-message, Republican leaders have managed to maintain iron-fisted control over their bill, successfully passing it out of both the Energy and Commerce and the Ways and Means committees without a single substantive amendment -- despite sessions of a combined 45 hours.
Rep. Joe Barton, a Republican from Texas, filed an amendment in the Energy and Commerce Committee markup that would have sunset the Medicaid expansion sooner than the 2020 deadline in the bill, but he pulled the proposal before it came up for a vote.
Conservatives opposed to the bill are ignoring warnings from GOP leaders that the bill will not get a significant face-lift, insisting they have leverage because the measure can't pass without buy-in from a major chunk of the Freedom Caucus. They are also eyeing the House Rules Committee, which is the final stop before the measure gets to the floor, as the opportunity to insert significant modifications.
"We're going to negotiate with the White House and with our leadership and they need our votes," Labrador said.
House Freedom Caucus Chairman Mark Meadows told reporters Friday that after the White House's meeting, he feels confident that the administration is willing to play ball.
"I am very confident based on my conversations with the White House that there is a willingness to negotiate in good faith things that drive down health care premiums," the North Carolina Republican said. "That being said, do I expect all of the issues that many of the Freedom Caucus members would like to have will be in a final bill that passes? The answer is no. So, it's about a good faith negotiation."
No matter what, expect the talks and proposals to continue.
"Despite what you hear in the press, healthcare is coming along great. We are talking to many groups and it will end in a beautiful picture!" Trump tweeted Thursday.