Washington (CNN) Top White House officials descended on Capitol Hill Thursday night to personally deliver President Donald Trump's ultimatum to House Republicans: Negotiations on their health care bill are over, and the House will vote Friday.

Then, there was this: If the bill doesn't pass Friday, Trump is ready to move on and Republicans will be "stuck with Obamacare."

That message, conveyed by Office of Management and Budget Director Mick Mulvaney to tired lawmakers over Chick-fil-A and Corner Bakery snacks, finally put an end to the looming question of whether the GOP health care legislation would end up on the House floor. It also dared Republican critics and skeptics of the bill like the conservative House Freedom Caucus to own the political consequences of reneging on the party's years-long pledge to gut President Barack Obama's landmark health care law.

The outcome of Friday's vote is unclear. If the bulk of the Freedom Caucus remains opposed to the bill, leadership does not believe it has the votes to clear the bill in the House.

According to CNN's ongoing whip count, 27 House Republicans have said they will vote against the bill and four more have indicated they are likely to oppose it. Republicans can't lose more than 21 members of their caucus and still pass the bill, since no Democrats are expected to support it.

The dramatic scene on Capitol Hill followed 24 hours of tense negotiations and hushed meetings on both ends of Pennsylvania Ave. By Thursday afternoon, GOP leaders had postponed the vote scheduled for that day.

The decision to end negotiations came from the White House, a person with direct knowledge said. Leadership and top White House aides spent the late afternoon "trying to grind them down," the source said, referring to the Freedom Caucus. But there was no clear progress, so in private conversations, even as meetings were ongoing with the Freedom Caucus, Trump made the decision to go ahead with the vote.

"There's nothing more we want to -- or really can -- give them," the source said

Trump and House Speaker Paul Ryan spoke by phone for nearly 45 minutes late Thursday, multiple sources told CNN. A source familiar with the discussions said was an "entirely positive call."

But the struggle to repeal Obamacare has highlighted both Trump's and Ryan's struggles to reconcile their own party's deep and glaring internal divisions.

Both men have been furiously lobbying lawmakers and especially the Freedom Caucus to get behind the legislation, as the group has tried to push the bill to the right but whose proposals have alienated moderate Republicans.

Meanwhile, the Congressional Budget Office came out with more bad news on Thursday. Changes Republicans made earlier this week to the bill will actually only decrease federal deficits by $150 billion over 10 years, while the original measure would have lowered deficits by $337 billion.

The measure still would leave 24 million fewer people insured by 2026 than under Obamacare, CBO said.

The challenge for leaders as they've counted their votes has been daunting: Give conservatives too much of what they want and risk losing the moderates, but keep the moderates on board and conservatives could walk.

On Wednesday and Thursday, non-Freedom Caucus Republicans began to turn their backs on the bill, saying it was not a plan they could back on behalf of their constituents.

The moderate Tuesday Group trekked to the White House Thursday afternoon after intense deliberations of their own and a meeting with Ryan. The group had seven boxes of pizza as well as Doritos and Baked Lays delivered to a room in the Capitol earlier in the day.

Even after Trump delivered his ultimatum Thursday night, some of the moderate Republicans previously opposed to the bill -- such as New Jersey Rep. Leonard Lance -- said they would still vote "no."

In trying to win votes for the health care bill, Trump has also experienced firsthand the reality of what it can be like to work with the Freedom Caucus, a top GOP source said -- that they can be deeply frustrating because they don't really want to get to yes and keep changing their demands.

The drawn-out exercise has also created hard feelings within the House GOP conference.

Alabama GOP Rep. Bradley Byrne, emerging from a meeting with top House leaders on Thursday, blasted the House GOP leadership's move to continue talks with the hard right in the Freedom Caucus while leaving the bulk of other members in the dark.

"I think the window for making decisions is rapidly closing. We need a vote or go home," said Byrne, a member of a large group of fiscal conservatives, the Republican Study Committee.

Moderates are unhappy

A key element of the negotiations between the Freedom Caucus and the White House revolved around the so-called "essential health benefits." Obamacare mandated that certain insurers to cover 10 services, including maternity, prescription drugs, substance abuse and mental health.

It has made coverage more comprehensive and prevented insurers from selling skimpy plans that were cheap, but didn't offer many benefits -- often leaving consumers with big bills if they needed care.

On the flip side, the measure has also driven up premiums and restricted consumers' choice to buy more limited coverage. Republicans have long wanted to get rid of the essential health benefits provision, which is key to their pledge to reduce premiums and offer choice to consumers.

Removing the provision could also greatly weaken the law's protection of those with pre-existing conditions. Without the requirement to cover comprehensive policies, insurers could opt exclude some of the priciest services that sick Americans.

The final bill that Republicans will vote for on Friday would repeal the essential health benefits provision.

That decision has frustrated plenty of Republican lawmakers.

"A lot of people don't realize what the implications of that are," one lawmaker said. "So we're gonna railroad this thing through and there's going to be even more people pissed off -- our constituents, stakeholders."

What's in the bill

The GOP health care bill, introduced earlier this month, would roll back many of the Obamacare taxes and eradicate the individual mandate. Instead of the subsidies available under Obamacare, officially known as the Affordable Care Act, the GOP plan provides Americans with refundable tax credits to purchase health insurance.

The bill also significantly restructures Medicaid and allows states to require able-bodied adults to work if they want to be eligible for the program. After 2020, states will no longer be able to expand Medicaid like they could under Obamacare and states that haven't expanded the program at all are barred from doing so.

However, the GOP bill still includes some of the most popular pieces of Obamacare, including letting children stay on their parents' insurance plans until the age of 26 and including protections for people with pre-existing conditions, though insurers would be allowed to charge higher premiums to individuals whose coverage has lapsed.

This story will continue to be updated as developments warrant.</s>WASHINGTON – Republican leaders in the U.S. House officially conceded Thursday afternoon what most observers already knew: They did not have the votes to pass a major overhaul of President Obama's 2010 health care law.

Early in the day, members and staffers close to leadership were predicting a late evening vote on the bill. The vote deficit, constantly charging, was minimal, they insisted.

But by the afternoon, it was clear the legislation was in severe jeopardy.

Twice on Thursday, U.S. House Speaker Paul Ryan postponed his weekly news conference. Those two moments were widely interpreted as a tell that he did not have the votes. Soon after his second delay, leadership confirmed to several news outlets they would not have a vote on the House floor Thursday night.

Texas Republicans for the most part were prepared to back the bill. In a delegation rife with committee chairmen and allies of leadership, most fell in line behind Ryan. Some were even excited to vote for repeal. Democrats were lined up against the proposal.

A Democratic member told the Tribune that their caucus was instructed to stay in town at least through Friday. Sources from both parties said that members were anticipating the possibility of continued negotiations and votes through the weekend.

But it was the replacement angle that tore the Republican conference apart. Some viewed the current proposal as leaving far too much of the Obama-era overhaul in place.

With no Democratic support, Republicans had a narrow margin of error in pushing the bill through the chamber. There were three Texas holdouts: U.S. Reps. Joe Barton of Ennis, Louie Gohmert of Tyler and Randy Weber of Friendswood. All three are members of a group called the Freedom Caucus who have bedeviled GOP vote counters for years.

Freedom Caucus members, including Barton and Gohmert, attended an intense negotiation with President Trump earlier on Thursday, an effort to salvage Thursday's vote. Hours later, House Republicans pulled the bill.

In the minutes after the vote cancelation news broke, Capitol Hill insiders were at a loss about what will happen next.

Republican members, staffers and consultants throughout the week would hardly entertain the idea that the Thursday vote would be canceled. By the afternoon, they were bracing for that lost legislative momentum to derail other agenda items, most notably tax reform.



Yet others noted that there were many times in 2009 and 2010 in which the Democratic push for a health care overhaul appeared dead.

Late Thursday afternoon, after it was clear that a vote wasn't going to happen that evening, Gohmert entered Ryan's office for a meeting between leadership and the Freedom Caucus.

"We've laid out our requests," he told reporters as he rushed by.

Meet Paige: Our new Facebook Messenger bot helps you keep track of the 85th Legislature. Subscribe by messaging HELLO to m.me/texastribune.org. Learn more.</s>Update, 3:36 p.m.: House GOP leadership has just announced that there will not be a vote on the healthcare bill today. The entire House GOP conference will meet tonight at 7 p.m. to discuss next steps. See below for more.

House Republican leaders were supposed to hold a vote on the health care bill tonight, but this morning, they weren’t ready yet.
• Why many are taking a wait-and-see view of GOP health care bill

The Rules Committee, which determines how the measure will be debated and voted on in the House, met for 12 hours yesterday, and adjourned after midnight without agreeing on a path forward.

The chairman of the House Freedom Caucus, Rep. Mark Meadows, had his own late night meeting — with President Trump over the bill. Many of the “no” votes that threaten to scuttle the bill come from members of the Freedom Caucus, which is made up of the most conservative members in the House. Meadows said he was “encouraged” by his meeting with the White House — their negotiations continued today.

The Freedom Caucus wants to lower premiums by rolling back what are known as the Obamacare “essential benefits” — like maternity care, emergency room visits, prescription drugs. But several moderates will likely reject this approach.

Republicans can lose up to 22 members, assuming that no Democrats will support the bill. Here’s the most current count of the “no” votes, according to CBS News.

3:36 p.m. House GOP leadership has just announced that there will not be a vote on the healthcare bill today. The entire House GOP conference will meet tonight at 7 p.m. to discuss next steps.

3:12 p.m. Ryan’s press conference has been postponed for a second time, CBS News’ Catherine Reynolds reports.

1:47 p.m. The Freedom Caucus is currently meeting behind closed doors on Capitol Hill. Amash said that eliminating essential health benefits isn’t enough and that adding it alone would make the measure worse, CBS News’ Catherine Reynolds reports.

Meadows said he wants the key provisions in the second phase of the repeal and replace strategy moved into this bill. He said that GOP leaders don’t have the votes to pass the current version.

1:44 p.m. House Freedom Caucus Chairman Mark Meadows, R-North Carolina, and Rep. Justin Amash, R-Michigan, just said that there is no deal between the White House and their conservative bloc of lawmakers, CBS News’ Walt Cronkite reports. With no deal, it’s unclear how Republicans will move forward and whether the vote will still occur Thursday night.

12:45 p.m. President Obama issued a statement earlier in the day marking the 7th anniversary of Obamacare.

“Thanks to this law, more than twenty million Americans have gained the security and peace of mind of health insurance,” he said. “Thanks to this law, more than ninety percent of Americans are insured – the highest rate in our history. Thanks to this law, the days when women could be charged more than men and Americans with pre-existing conditions could be denied coverage altogether are relics of the past.”

Obama said that seniors have bigger discounts on prescription drugs and young people can stay on their parents’ insurance plans until the age of 26.

“And Americans who already had insurance received an upgrade as well – from free preventive care, like mammograms and vaccines, to improvements in the quality of care in hospitals that has averted nearly 100,000 deaths so far,” he said.

12:43 p.m. House Minority Leader Nancy Pelosi, D-California, held her weekly press conference and mocked the president for having the healthcare vote scheduled on the anniversary of Obamacare being signed into law.

The House Republican conference was supposed to meet this morning at 9 a.m., but that meeting was postponed, CBS News’ Catherine Reynolds reported. House Speaker Paul Ryan was supposed to hold his weekly news conference at 11:30 a.m., but that’s now been pushed to 3:30 p.m.

The president is meeting with the House Freedom Caucus this morning, also at 11:30 a.m., on changes to the health care bill.
The U.S. House postpones the vote due to a lack of support and slow progress in dealmaking.