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Republicans scramble to rescue flailing health care bill

For Paul Ryan and other Republican leaders, improving the legislation isn't the point; passing the legislation is.
Image: House Speaker Paul Ryan Holds Weekly Briefing
U.S. Speaker of the House Paul Ryan (R-WI) explains the Republican plan to replace the Affordable Care Act in Washington, D.C. on March 9, 2017.
The quote may be apocryphal, but when Nancy Pelosi was Speaker of the House, she came to be associated with a simple phrase: "First you get the votes, then you take the vote."It seems like a strategy so obvious that it's hardly worth articulating -- along the lines of, "First you put on the shoes, then you tie the laces." And yet, the Pelosi Principle of passing bills is routinely overlooked by her Republican successors.Take, for example, the ongoing GOP plan to pass the Republican health care legislation. Instead of "First you get the votes, then you take the vote," House Speaker Paul Ryan (R-Wis.) is moving forward with a different tack: "First you schedule the vote, then you search for votes, then you significantly change the bill two days before the vote, and then you take the vote without any certainty about the outcome or the CBO score."Politico reported last night on the latest developments.

House Republican leaders are making a last-ditch attempt to win enough support to pass their Obamacare repeal, revealing an expansive series of changes to the bill on Monday night designed to woo wary GOP lawmakers.Requested by President Donald Trump, the amendment includes perks for restive conservatives who wanted optional work requirements and block granting in Medicaid, as well as a potential olive branch to wary centrists who demanded more help for older Americans to buy insurance, POLITICO has learned.

There are quite a few tweaks: more tax breaks for the wealthy, more punishments for the poor, some regional provisions targeted at specific GOP lawmakers, and a weird anti-abortion provision. Vox's Ezra Klein explained that none of the new provisions "meaningfully change the underlying legislation," nor do they "fix the old bill's problems."But for Republican leaders, improving the legislation isn't the point; passing the legislation is.So, will Ryan and the GOP leadership team manage to get the "American Health Care Act" through? To put it mildly, it's a fluid situation.Last week, the Speaker's office announced that the floor vote would be Thursday, apparently for symbolic reasons (March 23 is the anniversary of President Obama signing the Affordable Care Act into law). As things stand, the Congressional Budget Office has not yet scored the newest version of the health care legislation, and it's possible, if not likely, that members will vote on Thursday without a new CBO score -- meaning that lawmakers will consider legislation affecting tens of millions of Americans without knowing how much the bill would cost or how many families would lose their health security as a result of the plan.A variety of Republican opponents of the bill insist the bill doesn't have the votes to pass, but we have no idea if they're correct. We also don't know if GOP leaders will scrap their plans for a Thursday vote if they believe they're short. Even if it passes this week -- a distinct possibility -- opposition in the Senate is considerable.Donald Trump will reportedly head to Capitol Hill today to twist some arms and rally House Republicans to support the proposal, but everyone involved seems to recognize the underlying challenges: an unpopular president is trying to sell an unpopular bill while under a cloud of scandal.Ezra's piece added this thumbnail sketch: "Republican leaders have moved this bill as fast as possible, with as little information as possible, and with no evident plan for what will happen if the bill actually becomes law and wreaks havoc in people's lives. This is not the health reform package Donald Trump promised his voters, it's not the health reform package conservative policy experts recommended to House Republicans, and it's not the health reform package that polling shows people want."Other than that, though, everything's fine.