Where things stand with the Republican health care bill

It’s hard not to feel some trepidation about writing a piece on where things stand with the Republican health care bill, because the existing dynamic is subject to dramatic changes at a moment’s notice. But fortune favors the bold, so let’s dig in.Is the American Health Care Act going to pass today?That’s largely dependent on which version of the American Health Care Act we’re talking about. The original bill is dead. The revised bill, written in secret in the middle of the night earlier this week, doesn’t have the votes.So we’re just waiting for the bill’s inevitable failure?Not so fast. Overnight, there was talk of a new effort that would move the bill sharply to the right in order to make members of the House Freedom Caucus happy.What kind of changes are House GOP leaders prepared to offer?As of noon (ET), there is no new bill, but multiple reports suggest the Republican leadership is prepared to start scrapping essential health benefits — provisions in the Affordable Care Act that require insurers to cover things like prescription drugs and maternity care — in order to woo right-wing members.You’re making it sound as if some House Republicans believe the existing bill isn’t cruel enough.Yep.If the new, more far-right version becomes the official bill, will it pick up enough Freedom Caucus votes to pass?There is no headcount on this — the bill doesn’t yet exist, and may never exist — so no one knows for sure. For some Freedom Caucus members, scrapping essential health benefits is nice, but it’s not enough. Complicating matters, the House GOP’s center-right members are already running away from the bill, and their opposition will stiffen if the legislation becomes even more regressive.Has the bill — or any version of it — advanced to the floor from the House Rules Committee?As of this minute, no. In fact, the Rules Committee was instead working to override a House rule that prohibits the chamber from introducing and voting on a bill on the same day.What does the Congressional Budget Office have to say about the latest GOP plan?Not nearly enough. We have a CBO score on the original Republican bill, released by House Speaker Paul Ryan (R-Wis.) earlier this month, and there were rumors we’d see a new CBO score on the new GOP proposal last night. That did not happen. If Republicans rewrite their plan again, it could be a week before there’s a new report from the budget office about the bill’s costs and projected impact.What are GOP leaders saying about today’s schedule?The plan, as of yesterday afternoon, was to have the vote by 7 p.m. (ET) tonight. That’s still possible, but the Republican leadership has not yet said what anyone should expect and when. There was a House GOP conference meeting scheduled for this morning, but it was postponed.It seems unrealistic to think Republican leaders would rewrite their bill in secret, blow off the need for a CBO score, and bring it to the floor for a vote, all within the course of about six hours.Never underestimate the brazenness of these folks. In fact, this scenario remains a distinct possibility — despite the fact that we’re talking about life-or-death legislation that could strip tens of millions of Americans of their health security.Could a new-and-not-improved House bill pass the Senate?Probably not, but many of the Republican critics of the existing House bill have attacked it from the right. If Ryan makes the bill brutally more conservative, it may weaken the resolve of some of the bill’s Senate GOP critics.There’s also the Byrd Rule to contend with, which says bills advancing through the reconciliation process must only deal with budget/spending provisions. If Republicans start adding elements related to scrapping essential health benefits, procedural problems arise.How sure are we that the House vote will be today?Not very. Yesterday, Republican leaders said it was a lock: the vote would be Thursday. There have been quite a few rumors today, however, that if Ryan & Co. believe they’re close to dragging this thing across the finish line, they’ll grudgingly accept a delay.Anyone who says with confidence he/she knows how today will unfold is almost certainly wrong.