Health Care Vote Showdown: Republicans Look to Go Big or Go Home

Leigh Ann Caldwell and Hallie Jackson
The GOP's health-care vote is a huge deal...here's what the experts said on CNBC
The GOP's health-care vote is a huge deal...here's what the experts said on CNBC

Another day, another chance to pass the Republican health care plan.

After a difficult Thursday for Republicans who had hoped to have passed their bill to repeal and replace the Affordable Care Act, aka Obamacare, the House is back at it again Friday — but this time with a directive from the White House that it's now or never.

The House has scheduled a vote for their health plan, known as the American Health Care Act, for Friday afternoon. The postponement came after weeks of negotiations. which reached a breaking point Thursday as House leadership and the Trump administration seemed to be getting no closer to cobbling together the necessary 215 votes to pass the bill. Then President Donald Trump delivered a message to the House: If it doesn't pass Friday, we're moving on.

More from NBC News:
Republican Health Care Vote: Everything You Need to Know
Trump Ultimatum: Vote on Health Care Friday or Obamacare Stays
Meadows: We Don't Have Enough 'Yes' Votes to Pass Health Care

So House Republican leaders are moving forward with a vote on the American Health Care Act, regardless of whether they have the votes — a risk that could possibly deliver House Speaker Paul Ryan and President Trump a major defeat.

Of course, Republicans have been campaigning on repealing Obamacare since 2010, and Trump told his party members earlier in the week that reps could lose their seats if they don't pass the GOP replacement plan.

But the hard sell wasn't enough to convince those like Rep. Andy Biggs, R-Ariz., to climb on board. Late Thursday night he announced that he would vote against it, bringing NBC News' tally of "no" or "leaning no" votes to 32.

"I cannot support anything less than a clean repeal of Obamacare," Biggs said.

Questions will arise if GOP not cohesive at first test: BNP strategist
Questions will arise if GOP not cohesive at first test: BNP strategist

While the jockeying over what's in the bill continued, so did persuasion tactics.

White House aides, most notably Steve Bannon, Trump's chief strategist and senior adviser, spent the night working to convince the most conservative hold outs, telling them to "stand and deliver."

And sources said that Trump told conservatives on Thursday that they're asking for a lot while he told moderates that they've already received a lot.

Most Republicans were pleased that the vote was set for Friday. Inside a Republican meeting Thursday evening, some members said that it's time to vote and opponents would have to defend their positions.

Rep. Greg Walden of Oregon, the chairman of the House Energy and Commerce Committee who helped to usher the GOP health care plan through the drafting process, agreed with Trump's decision to cut off negotiations.

"I think it was time to have pencils down — time to move forward," Walden told reporters Thursday night.

But those undecided in their support of the AHCA were not necessarily ready to move forward so quickly.

"I always think if there's any chance whatsoever that we can make the bill better than we should never stop negotiations," said Rep. Trent Franks, an Arizona conservative who isn't yet supporting the measure. "Now, there is a time that those negotiations should stop but let that not be arbitrary, let that be on the timetable itself."

If Trump's health-care bill fails, expect a market correction: EIU
If Trump's health-care bill fails, expect a market correction: EIU

Trump's ultimatum was made after a week of hard selling by the president that peaked on Thursday when he had meetings with both the Freedom Caucus — the conservatives — and the Tuesday Group — the moderates.

Trump told Tuesday Group co-chair Rep. Charlie Dent, R-Penn., that he was "going to ruin the party," according to a source. The source said Dent "was listening."

Dent had come out against the bill because he is said too many people would lose their Medicaid coverage and the tax credits to help people purchase insurance aren't generous enough, especially for those aged 50 to 64.

Eleventh hour changes to the bill were made Thursday night — one more attempt to appease Republicans on both sides of the spectrum who weren't yet on board.

Those changes include a temporary extension of a 0.9 percent Medicare tax on people making more than $200,000. That expected to raise $15 billion for the Patient and State Stability Funds to help pay for maternity and newborn care as well as mental health and substance abuse. It's an effort to appease the moderates.

The other change would move the Essential Health Benefits from being a federal requirement and allow states to determine which ones they want to include in health insurance plans such as maternity care, hospitalization, emergency care, mental health services.

Those were just the latest round of changes that has been altered to appease the ideologically diverse caucus.

Trump's health-care repeal bill really just an adjustment: Novasecta
Trump's health-care repeal bill really just an adjustment: Novasecta

While the chance to make additional changes to the bill are over for the House, the White House and House leadership can still make future promises — something that has already been done through this process to get members on board.

Rep. Steve King of Iowa, for example, was promised that he would get a vote on a bill to ensure undocumented immigrants don't receive tax credits for purchasing health insurance. And upstate New York lawmakers were given a change in the Medicaid allocation that enables their region to get a higher percentage, something that would take money away from New York City.