After a month of education meetings and round-the-clock discussions with more than 150 members, House Republican leaders are still trying to work through disagreements with their fellow lawmakers over tax credits, the tax exclusion on employer plans and Medicaid changes.
House Speaker Paul Ryan, Vice President Mike Pence and Health and Human Services Secretary Tom Price are planning to rally public support for their repeal and replace plans Friday in Ryan's hometown of Janesville, Wisconsin, a messaging spectacle as a flurry of legislative discussion continues back on Capitol Hill behind closed doors.
Leaders have to please both conservatives and moderates because they cannot depend on Democrats to pick up any slack, creating a delicate balance to prevent loss of any one of their constituencies en masse.
Right now there is a dual track effort underway in the House, two committees working in tandem to find a bill that can assuage conservative concerns but all the while ensuring the proposal actually gets passed across the finish line.
The Ways and Means Committee is expected to work through the weekend to try and structure the refundable tax credits in a way that addresses conservative members' concerns. The Energy and Commerce Committee has made their committee staff available to meet with Republican committee members and answer questions.
Republicans are still working on significant pieces of the legislation, including how to structure tax credits that would help low-income people buy insurance. The issue has been a major sticking point with conservatives, who say refundable tax credits are little more than a subsidy or "Obamacare lite." Moderates, meanwhile, are concerned the tax credits would be available to everyone -- including the wealthiest Americans.
CNN confirmed that one idea being considered is to limit who is eligible for the tax credits so that the richest wouldn't get the money. But that does little to deal with conservative gripes about the plan's basic structure.
House Republicans also plan to discuss overhauling Medicaid this weekend. Under the plan now, the enhanced match for Medicaid expansion would be phased out starting in 2020. That would likely pass in the House, but it's unclear if the more than a dozen expansion-state Republicans in the Senate would agree to it.
But there are limits to what actually can be changed. Republican leaders still have to pay for their Obamacare replacement and give low-income individuals the ability to buy health care. They also must figure out a way to protect patients with pre-existing conditions while scrapping the individual mandate that was intended to help buoy those costs.
Adding to the theatrics this week was Sen. Rand Paul openly feuding with members of his own party
as he tried to make public the latest language of the House repeal bill, following the release of an earlier draft that angered conservatives.
The Kentucky Republican wrote a screed against leadership on social media and marched to the House side of the Capitol where he demanded that legislative aides show him the proposal. Aides repeatedly told him it wasn't there.
One senior Republican congressional aide warned that the time for stunts was quickly running out.
"There will come a time very soon where we're going to have to have a proposal. And, whether that be the House proposal or the Senate proposal, we're going to have a proposal and get 218 and 51," the aide said.
"So right now members can do what they're going to do, but that time for fun will end soon and members will be forced to make a very difficult decision very quickly," the aide added.
Following the leaked draft, leaders called in the Trump administration for reinforcements.
Price, a former congressman, came to the Hill to personally meet with Republican Study Committee Chairman Mark Walker of North Carolina, who'd come out against the language, and the HHS secretary continued to have conversations with members on the fence about the GOP plan. Many leaders also interpreted President Donald Trump's message on Obamacare Tuesday night as an endorsement of their bill
On Wednesday Energy and Commerce Chairman Greg Walden and House Ways and Means Chairman Kevin Brady ventured over the Senate to sell their plan in a meeting most senators described as "constructive," but Paul described as a meeting where senators were told to "take it or leave it."
"It's a bad strategy," Paul told reporters Thursday. "I think this strategy's a real poor one and I've already told them, I'm not voting for a new entitlement program. If they want new entitlement programs and they want new government, Obamacare-lite, they can put that separately as a replacement bill, but the repeal bill ought to be a repeal."
Other Republicans say that there is still room to for lawmakers to make changes, but they warn lawmakers not to let perfect be the enemy of the good.
"Anybody that has really good ideas. This is the time to bring 'em. Anybody who thinks that their bill is the only bill that can pass, that's not realistic," House Majority Whip Rep. Steve Scalise said Thursday. "At the end of the day, we're going to repeal Obamacare and replace it."
This story has been updated to reflect additional news.