Full speed ahead into a wall...

Decision day for Obamacare repeal

House Republicans barrel ahead with few votes to spare and no assessment of how much the bill would cost.

By KYLE CHENEY , JOHN BRESNAHAN and RACHAEL BADE

It's judgment day for the Republican plan to repeal and replace Obamacare.

House Republicans will huddle Thursday morning for what amounts to a last-minute pep rally to buck up colleagues as they prepare to take a vote to remake health insurance for millions of Americans. If recent history is a guide, it's a vote that will be career-changing — and perhaps career-ending — for many of the lawmakers who take it.

"I’ll take around 2,000 votes this Congress. Most of them will be forgotten," Rep. Ted Budd (R-N.C.) said late Wednesday. "This is not one of those votes. This vote marks the beginning of the end of Obamacare as we know it."

Though Republican leaders insisted Wednesday they've secured the 216 votes needed to pass their bill, the roll call will still be nerve-racking. At least 16 Republicans are still on record rejecting the proposal and about a dozen more are undecided. House leaders can afford only 22 defections, since Democrats will vote en masse against the proposal.

The House is scheduled to vote in the early afternoon.

Democrats complained that Republicans are jamming through a vote without knowing how much the plan will cost or how many people would lose their insurance. GOP leaders are refusing to wait for a formal assessment from the Congressional Budget Office. Instead, they're racing to capitalize on momentum from a day earlier, when a handful of holdouts came on board after a few final changes were made to the long-stalled bill.

The vote came together a week after conservatives in the hard-line House Freedom Caucus largely dropped their opposition to the bill. All but one — Rep. Andy Biggs (R-Ariz.) — are now expected to support the bill, according to three GOP insiders.

And in the final 24 hours, the House whip team was still notching additional support from moderates, flipping votes from members like Rep. Jeff Denham (R-Calif.), David Valadao (R-Calif.) and David Young (R-Iowa). Another holdout, Rep. Mark Amodei (R-Nev.), long a "no" vote, also dropped his objection late Wednesday, according to two GOP sources.

The legislation, the American Health Care Act, would slash Obamacare's taxes, phase out its generous Medicaid expansion, cuts down on its tax credits and — thanks to some last-minute maneuvering to win conservative support -— allow states to opt out of many of Obamacare's protections and coverage requirements.

To backers, it's a chance to throw off the regulatory yoke of the Democrat-passed law and create greater competition in health insurance. But critics, including Republican opponents, say the bill would undercut protections for the most vulnerable Americans — people with preexisting conditions who could be subject to premium spikes and reduced benefits if states opt out of the Obamacare framework.

The move to vote without a CBO assessment comes despite years of scolding attack ads from Republicans accusing Democrats of ramming through Obamacare without understanding its impacts. The CBO scored the Affordable Care Act before it was voted on.

An assessment of an earlier version of the AHCA estimated that as many as 24 million more people could go without coverage under the AHCA.

The vote will be particularly wrenching for Republicans who reside in districts won in November by Hillary Clinton. Members like Rep. Darrell Issa (R-Calif.), Mike Coffman (R-Colo.) and Kevin Yoder (R-Kan.) are still publicly undecided on the measure.

"Undecided and still reviewing changes," Issa wrote in a late Wednesday tweet. "Always like to actually read legislation and review its impact before taking a position!"

The stakes are also soaring for President Donald Trump, who spent weeks leaning on House members to revive the AHCA after multiple versions saw a collapse in Republican support. Trump spent the week dialing reluctant Republicans and pleading for their votes. When two prominent lawmakers defected, threatening the latest version of the bill, Trump hosted them at the White House on Wednesday and blessed a last-minute change to the bill in order to bring them back.

"He has been an aerobic listener through this entire process," said Rep. Michael Burgess (R-Texas), one of the health care law's top boosters in Congress, who joined Trump in the Oval Office on Wednesday to help broker the final amendment to win support for the measure.

One daunting reality for lawmakers reluctantly backing the bill is the near-certainty that many of its most controversial provisions could be dropped by the Senate, leaving only House members on the hook for the political costs. Senate Republicans have signaled little interest in the House version of the bill.

In a sign of the convoluted process Republican leaders are taking to try to unwind Obamacare, the House bill includes one provision that most members hate: an exemption from the law's impacts for members of Congress and their staffs. Though Republicans insist they don't want an exemption, technical Senate budgetary rules prohibit them from removing it without dramatically diminishing the chances of getting the bill through the Senate.

So House leaders have also scheduled a vote on a separate bill to eliminate the exemption. But Democrats have pounced on the procedural snafu to highlight the fact that the AHCA itself still includes the exemption.