WASHINGTON _ President Donald Trump and his inner circle are furiously courting the leaders of two key conservative factions in the House as dozens of Republicans still have serious concerns about the GOP plan to repeal and replace the Affordable Care Act.
"Frankly, I don't know that we are overly confident that the votes are there to move this through the House at this point," U.S. Rep. Mark Walker of North Carolina, head of the Republican Study Committee, said in an interview Monday. "There are a few things that are still concerns with some of our members."
Walker and Rep. Mark Meadows, R-S.C., head of the Freedom Caucus, think the Republican plan to repeal and replace President Barack Obama's health care law can go nowhere without the blessing of Congress' most conservative members.
With the bill scheduled for the House floor Thursday, Republican leaders must get Meadows, Walker and their constituencies on board. A review of lawmakers' statements on Ryan's plan shows the legislation close to failure. Just 21 Republican "no" votes would sink the bill, and about two dozen have indicated they are leaning against it.
Meanwhile, Walker estimated that 30 to 40 Republicans, both hard-line conservatives and moderates, still have serious concerns about House Speaker Paul Ryan's proposal. Trump plans to meet with House Republicans Tuesday to make another appeal for support.
The Freedom Caucus, the smaller of the two groups, with about 30 members, has enough power to run the health care bill aground even if some of its members wind up supporting it. The Republican Study Committee is much larger, with nearly 170 members.
No Democrats are expected to support the bill.
One criticism from the hard right is that Ryan's proposal doesn't go far enough to permanently unwind health care regulations introduced by the Affordable Care Act. Other conservatives condemn a Republican-proposed tax credit to help individuals pay for coverage, saying it amounts to a substitute for the current law's subsidy for low-income people.
The complaints _ with Walker and Meadows leading the charge _ have already prompted House Republicans to slow down long enough for more debate and changes.
The Republican Study Committee has pushed for amendments to the bill, including federal block grants for states to administer Medicaid programs with fewer regulations, adding work requirements for some Medicaid recipients who don't have physical disabilities and limiting health savings account tax-credit money from being spent for abortions.
"The caveat for us signing off on this is we have to see the language of these adjustments," Walker said. "We're in constant conversation with Ryan's office. ... This went on all weekend, back-and-forth discussions."
Meanwhile, Meadows over the weekend went to Trump's Florida resort Mar-a-Lago, the latest sign that he has been accepted as a sort of spokesman for right-wing concerns with the House bill. A Meadows spokesman didn't give details about the meeting with senior Trump staffers.
U.S. Sen. Ted Cruz, R-Texas, was also there. He said Sunday on CBS's "Face the Nation," that he, Meadows and Sen. Mike Lee, R-Utah, were negotiating with Trump's team over the health care bill, without being specific.
If Trump and Ryan lose the Freedom Caucus, they risk a stalemate in Congress over health care and potential backlash from the party's base if they're unable to do what Republicans have promised their voters for years: Get rid of the Affordable Care Act, repeal the mandate that most people must have health insurance or pay a fine, and loosen restrictions on insurance companies.
"We're hearing the same thing that we've been hearing (from voters) for the last eight years. ... They want this thing repealed," said Donald Bryson, state director for Americans for Prosperity in North Carolina.
The national group held a rally with hundreds of people at the U.S. Capitol this month with a singular message to Republicans in Congress: "You promised."
Bryson said Meadows and Walker were right to demand that the current law be fully gutted, without tax credits to buy insurance and without stipulations that insurance companies charge more for coverage if individuals let their plans lapse.
"Groups like Americans for Prosperity are going to be beating the drum on this," Bryson said. "The longer (Congress) waits, the louder the drum is going to be."
Conservative resistance was buoyed earlier this month by criticism from right-wing groups that the Ryan bill was effectively "Obamacare Lite" or a Republican-authored entitlement program.
Heritage Action, the political arm of the conservative Heritage Foundation, supports rolling back regulations on the health care industry associated with the Affordable Care Act.
"If Republicans want to have good policy ... but also have good politics, they have to make sure premiums go down," said Dan Holler, vice president for communications and government relations at Heritage Action. "And you can't do that if you have a whole suite of Obamacare regulations remaining in place."
The climate is almost perfect for Meadows to be on the front line of debate and dissent, said Andy Yates, a co-founder and senior partner at Red Dome Group, a political consultancy firm in North Carolina. Yates helped Meadows on his 2014 congressional campaign.
Meadows comes from a safe Republican district in western North Carolina and his national profile has risen alongside the House Freedom Caucus, a group he helped start two years ago partly out of frustration that rank-and-file conservative members had little influence on major pieces of legislation.
Also, Meadows _ who endorsed Cruz early in the 2016 presidential race _ ended up being a faithful campaigner for Trump in North Carolina after Trump won the Republican Party nomination. Meadows flew around the state on Trump's plane, attending campaign events even as other North Carolina Republicans cited scheduling conflicts and made limited public appearances with the candidate.
"There's a mutual respect there," said Yates, who was also a consultant for the Republican National Convention and Trump's inauguration committee.
