Non-partisan budget office says replacement for Affordable Care Act would leave millions uninsured but reduce federal deficit by $337bn in first 10 years 
 
 As many as 24 million Americans risk losing health coverage over the next decade under the Republican plan to replace the Affordable Care Act, popularly known as Obamacare, the non-partisan Congressional Budget Office said on Monday. 
 
 The report predicts a dramatic loss of healthcare coverage over the next decade if Congress enacts the Republican healthcare proposal, which has faced criticism from across the political spectrum and from nearly every sector of the healthcare industry. 
 
 An estimated 52 million people would be uninsured in 2026, compared with the 28 million who would lack insurance that year under the current law, according to the report. President Donald Trump, who supports the Republican plan, has promised that his plan would provide “insurance for everybody”. 
 
 The congressional analysts estimate that the Republican healthcare proposal could reduce the federal budget by $337bn over 10 years, with the largest savings coming from cuts to the federal Medicaid program and “Obamacare” tax credits for people who buy insurance individually. 
 
 Republicans were bracing for an unfavorable accounting from the budget office on Monday, as the bill, called the American Health Care Act, faces intensifying opposition from conservatives, Democrats, consumer interest groups and nearly every sector of the US healthcare industry. 
 
 Reacting to the report, health and human services secretary, Tom Price, said the CBO score is “just not believable” and the White House “strenuously” disagrees with its conclusion. He said the analysis only accounted for one phase of the three-pronged plan, which the White House believes would cover more Americans than the report estimated. 
 
 The House speaker, Paul Ryan, said the report confirms that his plan will “lower premiums and improve access to quality”, indicating that Republicans intend to press ahead with the legislation despite the sizable loss of coverage. 
 
 “Our plan is not about forcing people to buy expensive, one-size-fits-all coverage,” Ryan said in a statement. “It is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down.” 
 
 But Senator Susan Collins called the report a “cause for alarm” and urged her colleagues to slow down and revisit the replacement plan. 
 
 “This is an extremely important debate with significant implications for millions of Americans,” the Republican said. “We need to spend the time necessary to get this right.” 
 
 
 
 In the run-up to the publication of the CBO report, many Republicans began casting the expected drop in coverage as a consequence of having more choice. 
 
 “The one thing I’m certain will happen is CBO will say, ‘Well, gosh, not as many people will get coverage,’” Ryan said on CBS’s Face the Nation on Sunday. “You know why? Because this isn’t a government mandate.” 
 
 The report also concluded that barring Planned Parenthood from receiving federal dollars would amount to $234m less in Medicaid spending over 10 years. But about a third of those savings, the report warned, would be wiped out by unintended pregnancies caused when low-income or rural women lose access to contraceptive services. Planned Parenthood receives Medicaid reimbursements for providing STI and contraceptive services, but not abortions, to low-income patients at no cost. 
 
 In addition to increased spending on births, the report found, there would be unpredictable costs associated with the children, who could qualify for Medicaid and other federal programs. 
 
 Democrats, who had criticized Republicans for rushing the bill through key House committees before the CBO score was released, seized on the report’s findings and called on Republicans to drop the bill. 
 
 “The CBO report should be a knockout blow for Republicans in Congress,” the Senate Democratic leader, Chuck Schumer, told reporters during a joint press conference with the House minority leader, Nancy Pelosi, on Monday. “They should heed this warning and turn back from their plan that would be a disaster for the country.” 
 
 
 
 Pelosi echoed Schumer. “In terms of insurance coverage it’s immoral, in terms of giving money to the rich at the expense of working families it is indecent and wrong,” Pelosi said, adding: “I hope that they would pull the bill. It’s really the only decent thing to do.” 
 
 “It is abundantly clear why congressional Republicans wanted to rush their healthcare bill through committee during two middle-of-the-night markups – they know it is a fundamentally bad deal for Americans,” said the House Democratic caucus chairman, Joe Crowley of New York. 
 
 “Donald Trump’s ‘insurance for everybody’ pledge was a big fat lie,” the Democratic National Committee chairman, Tom Perez, said in a statement. 
 
 The ACHA seeks to radically transform and cut Medicaid, one of America’s largest social safety nets; end requirements for Americans to purchase healthcare; allow insurance companies to charge the old five times more than the young; expand tax-free health savings accounts; cut taxes that would disproportionately benefit the wealthy; and shrink subsidies that benefit the middle class. 
 
 At the same time, it allows insurance companies to levy a 30% surcharge on anyone who does not have insurance for more than two months, meant to incentivize people to keep insurance. 
 
 Repealing Obamacare: the healthcare people can least afford to lose Read more 
 
 When the ACA was passed, it sought to insure all Americans and standardize health benefits. The law passed consumer protections, expanded Medicaid to single adults and established subsidized marketplaces for individuals to buy insurance. 
 
 Though the GOP plan would scrap many of the existing law’s critical provisions, it keeps a handful of its most popular ones: a requirement that insurers cover the sick, allowing young people to stay on their parents’ health insurance, and a ban on lifetime coverage caps. 
 
 During the presidential campaign, Donald Trump touted a replacement plan that would “cover everybody”. 
 
 Earlier on Monday, Trump invited a group of people – referred to by the administration as “victims of Obamacare” – to the White House to share their recount their negative experiences with the healthcare law. 
 
 Among those Trump heard from during the listening session was a cattle rancher who said the increasing healthcare rates are hurting her family business and a stay-at-home mom who was forced to re-enter the workforce because the increase in the premium for their family insurance was unaffordable. Trump promised the table that the Republican plan would ensure “access for everyone”, a departure from his earlier promise to create universal healthcare. 
 
 However, that access would come with a price for some groups, the CBO predicted. Changes in the Republican bill could cause monthly costs for older, poorer Americans to rise dramatically. For example, a 64-year-old earning $26,500 a year would have annual out-of-pocket costs increase by $14,600, from $1,700 a year under current law. 
 
 By contrast, young people could see annual costs drop. A 21-year-old earning the same amount of money would pay just $1,450 out-of-pocket, a $250 decrease from current law. 
 
 With the GOP having only a two-vote majority in the Senate, the bill needs to bring warring factions together to pass, assuming Democrats uniformly oppose the bill. Yet conservatives remain staunchly opposed to the legislation in its current form, dubbing it “Obamacare lite”. 
 
 Heritage Action for America, one of the most influential conservative opponents of the Republican healthcare law, cast doubt on whether the bill has enough votes to pass the House. 
 
 
 
 “The biggest fear I have – what keeps me up at night – is that Republicans pass a healthcare bill that keeps the fundamental architecture of Obamacare,” Michael Needham, the CEO of Heritage Action, told reporters on Monday. “Then, in 2020 or 2024, the American people look at the mess and vote in a Democrat who says the answer is single-payer healthcare.” 
 
 “I would say to my friends in the House of Representatives with whom I serve: ‘Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote,’” Tom Cotton, a Republican senator for Arkansas, told ABC. “If they vote for this bill, they’re going to put the House majority at risk next year.” 
 
 Trump supporters in the heartland fear being left behind by GOP health plan Read more 
 
 Equally as blunt, Rand Paul, a Republican senator for Kentucky, said of Ryan’s plan: “He will not have the votes.” 
 
 A handful of GOP senators have criticized the bill for not protecting Medicaid beneficiaries, and two Republican senators have objected to the provision stripping Planned Parenthood of federal funding. 
 
 House Republicans have pressed ahead quickly with the bill, which was unveiled last week. The healthcare plan was approved by two key House committees last week after all-night debates and despite objections from Democrats, who argued that it was critical to know the findings of the CBO report first. The proposal will next head to the House budget committee. 
 
 A preliminary assessment from the ratings agency S&P Global suggested between two million and four million people who are insured through the individual insurance market under the healthcare law could lose coverage, as well as between four million and six million people who are currently enrolled in Medicaid. 
 
 At the same time, as debate on the ACA has heated up its popularity hit a historic high in February, according to findings from the Pew Research Center and the latest Kaiser Health Tracking poll. The result is the highest level of support for the law in the 60 tracking polls Kaiser Health has conducted since 2010. 
 
 Molly Redden contributed to this report ||||| Republican senators are struggling to articulate why they are rushing to pass their last-ditch effort to repeal and replace Obamacare over the next 10 days before running into their September 30 deadline. 
 
 In interviews with Vox on Tuesday, nine Republican senators primarily argued that their “Hail Mary” bill — spearheaded by Sens. Lindsey Graham (SC) and Bill Cassidy (LA) — would return federal power to the states, giving them greater flexibility to improve their health systems locally. “The heart of the legislation takes the policymaking role of Washington and sends it to the states,” Texas Sen. Ted Cruz said. 
 
 Far less clear is exactly how Graham-Cassidy would pull off this feat without resulting in millions of Americans losing their insurance — and the number of millions is still unknown, since any vote would likely have to come before the Congressional Budget Office completes its analysis of the bill. The GOP senators insisted that the tens of billions in cuts to federal health spending proposed in the bill would not result in coverage losses because, they said, the states would have more flexibility. 
 
 “They can do it with less money,” said Sen. Jim Inhofe (R-OK), who was unable to explain how or why. 
 
 Other Republican senators, meanwhile, fell back on political explanations for a bill that experts warn could result in millions losing their insurance. “If we do nothing, it has a tremendous impact on the 2018 elections,” said Sen. Pat Roberts (R-KS). “And whether or not Republicans still maintain control and we have the gavel.” 
 
 And then some members of the upper chamber acknowledged that the spending changes might have a big impact, but argued their home states would not be negatively impacted. “Four of our states are getting a disproportionate amount of money from health care now,” Sen. Richard Shelby (R-AL) said. The bill, he added, “wouldn’t cut Alabama.” (Numbers from the Center on Budget and Policy Priorities suggest Alabama would receive more than $1 billion in additional funding under the bill, but most states would see big cuts.) 
 
 The stakes of the Republican rush to repeal and replace Obamacare could hardly be higher. The GOP has less than two weeks to pass a repeal-and-replace plan before their budget reconciliation instructions expire, and the insurance of tens of millions of Americans hangs in the balance. 
 
 Vox conducted the interviews with nine Republican senators throughout the Capitol and Russell Senate Office Building on Tuesday. 
 
 Transcripts of those conversations follow. 
 
 Sen. Pat Roberts (R-KS): “If we do nothing, it has a tremendous impact on the 2018 elections” 
 
 Jeff Stein 
 
 Senator, I wanted to ask you for a policy-based explanation for why you’re moving forward with the Graham-Cassidy proposal. What problems will this solve in the health care system? 
 
 Pat Roberts 
 
 That — that is the last stage out of Dodge City. 
 
 Jeff Stein 
 
 I’m just trying to explain to our readers what the policy — 
 
 Pat Roberts 
 
 What readers? Who do you represent? 
 
 Jeff Stein 
 
 It’s a website called Vox. 
 
 Pat Roberts 
 
 ... [Graham-Cassidy] is the last stage out of Dodge City. I’m from Dodge City. So it’s the last stage out to do anything. Restoring decision-making back to the states is always a good idea, but this is not the best possible bill — this is the best bill possible under the circumstances. 
 
 If we do nothing, I think it has a tremendous impact on the 2018 elections. And whether or not Republicans still maintain control and we have the gavel. 
 
 Jeff Stein 
 
 But why does this bill make things better for Americans? How does it help? 
 
 Pat Roberts 
 
 Pardon me? 
 
 Jeff Stein 
 
 Why does this make things better? What is this doing? 
 
 Pat Roberts 
 
 Look, we’re in the back seat of a convertible being driven by Thelma and Louise, and we’re headed toward the canyon. That’s a movie that you’ve probably never seen — 
 
 Jeff Stein 
 
 I do know Thelma & Louise, sir. 
 
 Pat Roberts 
 
 So we have to get out of the car, and you have to have a car to get into, and this is the only car there is. 
 
 Sen. Jim Inhofe (R-OK): “Efficiencies” from federal-state transfer “can very well make up the difference” 
 
 Jeff Stein 
 
 What’s the policy explanation for the Graham-Cassidy bill? What substantive problems does this solve? 
 
 Jim Inhofe 
 
 Well, first of all, as a general rule the states do things better than the federal government does [things]. And that is essentially what the bill is. We actually had a bill that passed, except at the last minute — as you know — we had one deciding vote against it that was unforeseen. And I think what we’re looking at right now is essentially the same thing. 
 
 It’s a stronger position for the states to be in, and generally, Republicans agree with that. 
 
 Jeff Stein 
 
 I understand what you’re saying with the states having the ability to make these decisions, but the bill doesn’t just “give states more freedom” — it also cuts federal funding to the states. So it’s not just about giving the states more control; it’s also about cutting federal expenditures, right? 
 
 Jim Inhofe 
 
 Well, yes, but that doesn’t mean it’s going to be — I think the efficiencies that come with transferring the funding to the states can very well make up the difference between what the federal thing would be. 
 
 A philosophical difference — you know? 
 
 Jeff Stein 
 
 No, what do you mean? 
 
 Jim Inhofe 
 
 I mean it’s more efficient when it’s done from the states, and so they can do it with less money. 
 
 Jeff Stein 
 
 Are you confident, and how do you know those savings will be close to enough to protect everyone? 
 
 Jim Inhofe 
 
 Well, nothing protects everyone. 
 
 Sen. Ted Cruz (R-TX): “It lets states innovate and adopt creative solutions” 
 
 Jeff Stein 
 
 I’m looking for a broad policy explanation for what Graham-Cassidy will do — how does it improve the American health care system? 
 
 Ted Cruz 
 
 Well, the details of it are still being negotiated, but the heart of the legislation takes the policymaking role of Washington and sends it to the states. It lets states innovate and adopt creative solutions to local problems, which vary state by state. 
 
 Jeff Stein 
 
 But it’s not just devolving power from the federal government to the state. It also involves a 16 percent cut in federal spending [upfront] and a 34 percent cut over the next 10 years. 
 
 If you’re saying, “Let’s just devolve power to the states,” why also cut federal spending so dramatically? 
 
 Ted Cruz 
 
 My central focus from the beginning has been on lowering health insurance premiums. 
 
 The biggest reason so many millions of people are hurting under Obamacare is that it has made premiums skyrocket. And what I think is critical for Obamacare repeal is that we expand consumer freedom so that you, the consumer, can be in charge of what health insurance you want to buy, and we lower premiums so that health insurance is more affordable. ... 
 
 Jeff Stein 
 
 Why not wait until the CBO says what you’re saying about premiums? Why not confirm with them? Over the first few votes, the CBO suggested that premiums would go up and that tens of millions of people would lose health insurance. 
 
 Ted Cruz 
 
 CBO’s analysis throughout this process has been ridiculously slow, unreliable, and based on policy assumptions that are demonstrably false. 
 
 Jeff Stein 
 
 You really believe that cutting federal spending by 34 percent will not result in any other people losing their insurance? 
 
 Ted Cruz 
 
 What federal spending is cut? 
 
 Jeff Stein 
 
 Well, the Medicaid expansion would be sunset, for one, is my understanding. 
 
 Ted Cruz 
 
 The decrease in future rates of growth is not a cut. And it is only in the bizarre world of Washington that billions more money is characterized in the press as a cut rather than an increase, which is in fact what it is. 
 
 Sen. John Kennedy (R-LA): “Read the bill and you’ll understand” 
 
 Jeff Stein 
 
 What are the policy explanations for the bill? 
 
 John Kennedy 
 
 I think it’s an improvement over Obamacare, but I have sent four amendments to Lindsey [Graham] and Bill [Cassidy] that I think will strengthen the bill. The one I feel most strongly about is that I want the Medicaid work requirement — I don’t want it to be optional; I want it to be a requirement. Just like we did with welfare reform. 
 
 And number two, I want to get us to give guardrails to the states to say, “You cannot use these moneys to set up a state-run single-payer system.” I don’t believe in it. I think it’s a mistake. 
 
 I’ve lived under a single-payer system, and I think the bill would be stronger with that prohibition. [That’s an apparent reference to England, where Kennedy received a law degree in the 1970s and which has the National Health Service.] 
 
 [Guardian reporter] Lauren Gambino 
 
 Do you think that kind of goes against the idea of states’ rights and being able to use this money [as the states want to]? 
 
 John Kennedy 
 
 No, no. We have plenty of federal rules that apply to every state, but we still agree with states’ rights. 
 
 Jeff Stein 
 
 What are the main policy explanations for getting behind this bill? What does this bill do right, policy-wise? 
 
 John Kennedy 
 
 I think it’s an improvement over Obamacare. 
 
 Jeff Stein 
 
 Why? 
 
 John Kennedy 
 
 My position has always been that, number one, I think Obamacare has been a failure. 
 
 Number two: First chance I get to vote for repeal it, I’ll do it. 
 
 And number three: If it’s replacement, if replacement is better than Obamacare, I will vote for it. 
 
 Jeff Stein 
 
 What are the policies that make you think that? 
 
 John Kennedy 
 
 I think it spends scarce resources in a more rational manner. It will control costs. I like the idea that it encourages states to innovate. 
 
 Jeff Stein 
 
 How does it do that? Any of those things? 
 
 John Kennedy 
 
 Well, you need to read the bill. 
 
 Jeff Stein 
 
 Well, you’re voting for it, right? So what is the explanation for how it does those things? 
 
 John Kennedy 
 
 I am. Because it gives states added flexibility. Read the bill and you’ll understand. 
 
 Sen. Richard Shelby (R-AL): “It wouldn’t cut Alabama, though” 
 
 Jeff Stein 
 
 In broad strokes, what do you think this bill is going to accomplish? 
 
 Richard Shelby 
 
 This is what a lot of us ran on — we’ve been advocating it for years. Let the states run it. They know more about it. They run the Medicaid program. They run our highway programs. We send 80 percent of money to various transit and highway stations — there, where the rubber hits the road. 
 
 Jeff Stein 
 
 But it’s not just that it devolves power to the states — it also involves a 16 percent cut in federal health spending. 
 
 Richard Shelby 
 
 But I’ll tell you what: Our states — our 50 states — are very flexible, very innovative. Much more so than we are here. I think it will work, and it will be a big step toward federalism. 
 
 Jeff Stein 
 
 The bill would cut federal funding to states by 34 percent over the next — 
 
 Richard Shelby 
 
 But it wouldn’t cut Alabama, though. 
 
 Jeff Stein 
 
 Well, do you think the other states should deal with — 
 
 Richard Shelby 
 
 Well, you see some of our states, four of our states, are getting a disproportionate amount of money from health care now. You know which ones. 
 
 Sen. Johnny Isakson (R-GA): “I don't know what the numbers are going to end up looking like” 
 
 Jeff Stein 
 
 What is the policy explanation for the Graham-Cassidy health care bill? 
 
 Johnny Isakson 
 
 Policy explanation? I’m not into policy, so I don’t really know. I’m into facts. 
 
 Jeff Stein 
 
 [In a follow-up interview hours later on Tuesday] You were joking earlier, but what is the health policy in the Graham-Cassidy proposal that you like? 
 
 Johnny Isakson 
 
 More state innovation. More input from the states. 
 
 Jeff Stein 
 
 What does that mean, exactly? 
 
 Johnny Isakson 
 
 The governors — I'm from a state that didn't expand Medicaid, and the way we were going in health care looked like those states would actually be hurt worse than other states. 
 
 By going to block grants, back to the states, the control of money stays with the states, and you have less [un]predictability and external deviation in terms of funding. 
 
 Jeff Stein 
 
 So just a follow-up on that. It's one thing to say the bill gives the states power — that’s one thing. 
 
 But it doesn't just do that. It also cuts the money they have — some estimates say around 16 percent of federal funding. 
 
 Johnny Isakson 
 
 I'm not going to confirm that statement one way or another. I don't know what the numbers are going to end up looking like. 
 
 Jeff Stein 
 
 Right, but if it does cut federal spending overall, would you support it? 
 
 Johnny Isakson 
 
 You know, those are dangerous questions. I'm waiting until I see the totality of the legislation to say whether I support the whole thing or not, anyway. 
 
 I'm not a no, but I'm not a yes either — and I'm waiting for my governor to respond to me with their input as well. It’s really key what they’re doing. 
 
 Sen. John Barrasso (R-WY): “The governors who decided to expand [Medicaid] knew that they were going to lose federal funding” 
 
 Jeff Stein 
 
 I want to ask, in a big-picture way: What is the policy explanation for how this bill makes people’s lives better? 
 
 John Barrasso 
 
 It gets the money out of Washington, lets people at home make the decision, and gets state legislatures involved, and governors involved. It moves money out of Washington. It’s away from socialism. 
 
 Jeff Stein 
 
 CBPP says it will also reduce federal health spending on Medicaid and the exchanges by about [20] percent. 
 
 John Barrasso 
 
 I’d love to reduce federal spending on health insurance. 
 
 Jeff Stein 
 
 Right, but so it’s not just about moving power to the states — it’s also about cutting funding. 
 
 John Barrasso 
 
 It’s about moving power to the states, where money can be spent much more effectively. 
 
 Jeff Stein 
 
 How does it do that? 
 
 John Barrasso 
 
 Well, you have to read the formula and read the bill, and it will tell you how it moves money to the states and how much they get and how much they don’t get. ... 
 
 Jeff Stein 
 
 There’s a concern from Republican governors who have come out and said, “This is too dramatic a cut in spending; we won’t have enough money to insure everyone.” 
 
 John Barrasso 
 
 You have to interview them on that. 
 
 Jeff Stein 
 
 Do you think they’re wrong? 
 
 John Barrasso 
 
 Well, it depends on if they’re states that expanded Medicaid or not. ... 
 
 Jeff Stein 
 
 In the Medicaid expansion states, they still have a lot of people who rely on Medicaid expansion for health insurance. 
 
 John Barrasso 
 
 I opposed Medicaid expansion. I think the Supreme Court got it wrong [when it ruled in 2012 that Congress did have the constitutional authority to implement most of Obamacare]. 
 
 The governors who decided to expand [Medicaid] knew that they were going to lose federal funding over time, and they’re objecting to that — but they knew it. You could say, “Some of them didn’t understand it, and so-and-so wasn’t there, and he wasn’t governor yet,” but they understood that this would be part of the process. So if they used the money poorly — 
 
 And my concern with Medicaid is that the people who Medicaid was designed for originally have been cut out of the process, because they’re still on the waiting list to get on Medicaid. I don’t know how much you understand about Medicaid, but this whole expansion of Medicaid went for healthy, working-age individuals — it did not go for the people who [Medicaid] was designed for, which was low-income women, children, and the disabled. 
 
 Sen. Luther Strange (R-AL): “I like the idea of sending money back to the states and letting the states experiment” 
 
 Jeff Stein 
 
 I had a quick question on the Graham-Cassidy bill — could you explain what the policy purpose of the bill is? What is this bill going to achieve, policy-wise? 
 
 Luther Strange 
 
 Honestly, I have a meeting to talk about that shortly — so let me get back to you on that shortly. I have to talk to my staff. 
 
 Jeff Stein 
 
 [In a follow-up conversation with Strange about eight hours later] 
 
 So what do you think? 
 
 Luther Strange 
 
 We’re still looking at the details on how it affects Alabama, so we haven’t taken a position on it yet. 
 
 I like the idea of sending money back to the states and letting each state experiment with what’s best for their citizens. But I haven’t seen enough detail to know how it affects Alabama to have taken a position on it. 
 
 Jeff Stein 
 
 Do you worry about the billions in cuts in federal health care expenditures? 
 
 Luther Strange 
 
 That’s the kind of detail I haven’t seen on how it would affect our state. 
 
 Jeff Stein 
 
 Anything in particular you’ll be looking for? 
 
 Luther Strange 
 
 How it affects the state of Alabama, and how we are treated as a non-expansion state. 
 
 Jeff Stein 
 
 Will you be looking for protections for those with pre-existing conditions? What else matters? 
 
 Luther Strange 
 
 All of the above. 
 
 Sen. Chuck Grassley (R-IA): “This is the last attempt to do what we promised in the election” 
 
 Jeff Stein 
 
 I was hoping you could explain, in broad detail, what the point of Graham-Cassidy is. 
 
 Chuck Grassley 
 
 Let me give you a political answer, and then I’ll give you a substance answer. 
 
 The political answer is that Republicans have promised for seven years that we were going to correct all the things that were wrong with Obamacare, and we failed the first eight months. This is the last attempt to do what we promised in the election. 
 
 The substance answer is that Obamacare starts with the principle that all knowledge about health care, and all decisions on health care, ought to rest in Washington, DC. The complete opposite of that is Graham-Cassidy, that Washington doesn’t know best and we’ll let each of the 50 states [decide what’s best]. 
 
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 Are you an Obamacare enrollee interested in what happens next? Join our Facebook community for conversation and updates. ||||| WASHINGTON (AP) — In a gamble with monumental political stakes, Republicans set course for a climactic House vote on their health care overhaul after President Donald Trump claimed he was finished negotiating with GOP holdouts and determined to pursue the rest of his agenda, win or lose. 
 
 House Speaker Paul Ryan set the showdown for Friday, following a nighttime Capitol meeting at which top White House officials told GOP lawmakers that Trump had decided the time for talk was over. 
 
 "We have been promising the American people that we will repeal and replace this broken law because it's collapsing and it's failing families. And tomorrow we're proceeding," Ryan tersely told reporters after scheduling what loomed as the most momentous vote to date for Trump and for the Wisconsin Republican's own speakership. 
 
 In an embarrassing and stinging setback hours earlier, leaders abruptly postponed the vote because a rebellion by conservatives and moderates would have doomed the measure. They'd hoped for a roll call Thursday, which marked the seventh anniversary of President Barack Obama's enactment of his landmark health care statute that Republicans have vowed ever since to annul. 
 
 There was no evidence that leaders had nailed down sufficient support to prevail, nor that their decision to charge ahead was a feint and that they'd delay again if necessary. But they seemed to be calculating that at crunch time, enough dissidents would decide against sabotaging the bill, Trump's young presidency and the House GOP leadership's ability to set the agenda, with a single, crushing defeat. 
 
 "The president has said he wants the vote tomorrow," White House budget chief Mick Mulvaney told the lawmakers, according to Rep. Chris Collins, R-N.Y., a Trump ally. "If for any reason it goes down, we're just going to move forward with additional parts of his agenda. This is our moment in time." 
 
 Even if they prevail, Republicans face an uphill climb in the Senate, where conservatives and moderates are also threatening to sink it. 
 
 The GOP bill eliminates the Obama statute's unpopular fines on those who do not obtain coverage and the often generous subsidies for those who purchase insurance. 
 
 Instead, consumers would face a 30 percent premium penalty if they let coverage lapse. Republican tax credits would be based on age, not income. The bill would also end Obama's Medicaid expansion and trim future federal financing for the federal-state program and let states impose work requirements on some of its 70 million beneficiaries. 
 
 In a bid to coax support from conservatives, House leaders proposed a fresh amendment — to be voted on Friday — repealing Obama's requirement that insurers cover 10 specified services like maternity and mental health care. Conservatives have demanded the removal of those and other conditions the law imposes on insurers, arguing they drive premiums skyward. 
 
 Many moderates are opposed because they say the GOP bill would leave many voters uninsured. Medical associations, consumer groups and hospitals are opposed or voicing misgivings, and some Republican governors say the bill cuts Medicaid too deeply and would leave many low-income people uncovered. 
 
 Republicans can lose only 22 votes in the face of united Democratic opposition. A tally by The Associated Press found at least 32 "no" votes, but the figure was subject to fluctuation amid frantic GOP lobbying. 
 
 Rep. Mark Meadows, R-N.C., head of the hard-right House Freedom Caucus, said he remained a "no" but didn't answer when asked whether the group still had enough votes to kill the legislation. He'd long said caucus opposition alone would defeat it without changes. 
 
 One member of that group, Rep. Paul Gosar, R-Ariz., responded indirectly when asked if his opposition had changed. 
 
 "Everybody asked us to take a moment and reflect. Well, we'll reflect," he said. 
 
 Other foes said they'd not flipped. These included moderate Reps. Charlie Dent of Pennsylvania, Dan Donovan of New York and Leonard Lance of New Jersey, plus conservative Walter Jones of North Carolina, who had his own words of warning. 
 
 "He's there for three-and-a-half more years," Jones said of Trump. "He better be careful. He's got a lot of issues coming." 
 
 The nonpartisan Congressional Budget Office said changes Republican leaders had proposed before Thursday to win votes had cut the legislation's deficit reduction by more than half, to $150 billion over the next decade. But it would still result in 24 million more uninsured people in a decade. 
 
 Obama's law increased coverage through subsidized private insurance for people who don't have access to workplace plans, and a state option to expand Medicaid for low-income residents. More than 20 million people gained coverage since the law was passed in 2010. 
 
 Many who purchase individual health insurance and make too much to qualify for the law's tax credits have seen their premiums jump and their choices diminished. 
 
 ___ 
 
 Associated Press writers Matt Daly, Kevin Freking, Mary Clare Jalonick, Richard Lardner, Stephen Ohlemacher, Vivian Salama, Ken Thomas and Erica Werner contributed to this report.
– President Obama hates it, but that sentiment about the Senate Republicans' plan to replace ObamaCare isn't quite unanimous. Here's a look at what editorials are saying: Wall Street Journal: It implores Republicans to get this passed and not wilt under pressure from the media and Democrats. The measure is an "imperfect compromise" but also a "major improvement over the US health-care status quo that will worsen if the bill fails," write the editors. "It’s not too much to say this is a defining moment for whether the GOP can ever reform runaway entitlements." New York Times: This isn't a health care bill, say the editors. "It is, plain and simple, a plan to cut taxes for the wealthy by destroying critical federal programs that help provide health care to tens of millions of people." The bill's creators now have to bargain with holdouts to get it into final form, but "no amount of tinkering around the edges" can save it. If passed, it will take a "devastating toll on millions of Americans." Washington Post: The bill "includes a range of mostly unwise and ungenerous changes to the nation’s health-care system, but it might, if enacted, end up as mostly a massive, unpaid-for tax cut for wealthy people and industries with pull on Capitol Hill," says the editorial. Ditching the individual mandate in particular would inject chaos into health insurance markets. Washington Examiner: The conservative paper opposes the bill for not going far enough to dismantle ObamaCare. "The Better Care Reconciliation Act isn't a bill to reform healthcare. This is a bill to notionally repeal Obamacare while propping the insurance market up through the next election. It's an exercise in political box-checking and ass-covering." Forbes: This isn't an editorial, but an op-ed by Avik Roy that argues the Senate bill will "transform" US health care for the better. For conservatives tempted to vote no, he asks: "How many times in your life will you have the opportunity to vote for a bill that fundamentally transforms two entitlement programs? How often will you get to vote for a bill that cuts spending by hundreds of billions of dollars? How often will you get a chance to make a difference for millions of your constituents who are struggling under the weight of rising premiums and exploding deductibles?"