Don't look now but the Republican health care bill is in trouble again. Again.

Story highlights

  • The momentum among undecideds is all against the bill
  • President Donald Trump is also not helping the matter with his confusing and contradictory comments

(CNN)The third time may not be the charm for House Republicans.

After two failed attempts to gather enough votes to pass a bill that would repeal and replace the Affordable Care Act -- one in March and again last week -- it appears the Republicans are headed toward the same fate again.
According to CNN's whip count maintained by the terrific MJ Lee and Lauren Fox, there are now 21 House Republicans on the record as "no" votes. Lose two more and the bill fails. Again.
The Republicans' latest math problem comes just hours after Gary Cohn, the director of the National Economic Council, insisted that not only did Republicans have the votes for the legislation but that the bill would be voted on this week.
White House press secretary Sean Spicer sought to walk that back during his daily press briefing Monday.
"I would assume today we're closer than we were a week ago," Spicer said of the bill. "But we're not there yet."
That jibes with my conversation with a senior House Republican who told me this morning that Cohn had gotten out over his skis with a pledge to vote -- and pass -- health care this week.
"Clearly, when you have a big majority, there are people in tough districts who need to vote 'no,'" the GOP House member said. "However, there appear to be a lot of folks who aren't in tough districts who are still voting 'no.' We have a little work to do. I don't expect a vote this week."
Even that optimism -- that the rock is being rolled in the right direction and that the "yes" vote will materialize at some unknown point in the future -- seems somewhat optimistic given the number of "no" votes as of today.
Is it possible that only one of the 12 House Republicans who are currently undecided on the latest version of the healthcare bill will decide to vote for it? Sure! (As Kevin Garnett told us: "Anything is possible!") But, the momentum among undecideds is all against the bill, and you can be sure that if it looks like it can't get the votes, you will see swing Republicans run away from it.
President Donald Trump is also not helping the matter with his confusing and contradictory comments about whether the final version of the bill will mandate that insurance companies cover people with pre-existing conditions -- as the ACA currently does.
"Pre-existing conditions are in the bill. And I mandate it. I said, 'Has to be,'" Trump said to CBS's John Dickerson. Then today, in an interview with Bloomberg, Trump doubled down. "It will be every bit as good on pre-existing conditions as Obamacare," he said.
Here's the problem: The bill as currently constituted would keep the Obamacare mandate that people with pre-existing conditions be covered, but would allow states to apply for waivers that could greatly change the cost and quality of that coverage. That's how the White House and Republican House leaders convinced the Freedom Caucus, the most conservative wing of the GOP, to be for this version of the bill after they opposed the last one. Change the bill back to include a mandate and lots of Freedom Caucus support walks away.
What Trump and his administration seem to be saying is that by resurrecting high-risk pools they can ensure people with pre-existing conditions be covered. But, that's a giant question mark with an equally giant price tag. And with no idea how it might be paid for.
If two more House Republicans come out against this latest iteration of the healthcare bill, it's fair to ask whether there is ANY deal surrounding the repeal and replacement of Obamacare that can get the 216 votes Republicans need to pass it (assuming every Democrat shows up for the vote.) Based on the evidence I've seen since Republicans began the formal attempt to change the health care system back in March, count me as skeptical that majority exists right now.