Rebecca Zisser / Axios

It looks like the House Republican health care bill may be coming back to life after all. And if the leadership is this close to having 216 votes, they may well get the rest when the roll call starts. But don't get the impression this means the Affordable Care Act repeal effort is alive and well. This is Republicans just scraping by, getting a deeply unpopular bill off of their plates as quickly as they possibly can.

The debate in two quotes:

  • "The president has worked to make sure that in every single scenario, anybody — everybody — he has kept true to his word that pre-existing conditions are covered." — White House press secretary Sean Spicer
  • "Hey GOP, don't ever lecture us again on fiscal responsibility. You're about to reorder 1/6 of the US economy w no idea what it costs." — Tweet from Democratic Sen. Chris Murphy

Here's what to keep in mind for today's vote:

  • The bill is now a patchwork of classic Republican health care ideas mixed in with just enough concessions to conservatives and moderates to attract the bare minimum votes that they need.
  • The final change, the one that won the votes of Rep. Fred Upton and a few others, was an $8 billion fund created by an amendment that no one outside of a handful of Republicans even saw before last night.
  • The House will vote on this version of the Affordable Care Act replacement without a Congressional Budget Office estimate, and therefore no idea what it costs, how many people it might help, or how many it might hurt.
  • What Republicans will gain from this vote: They'll be able to say they didn't give up on their campaign promises to get rid of Barack Obama's health care law.
  • They'll also be able to put some of their ideas into practice, like lowering insurance prices through competition and flexibility.
  • In an op-ed for CNBC last night, Health and Human Services secretary Tom Price noted that it will also give states waivers from some of the ACA's insurance rules, "based on the insight — gleaned from experience, not partisan ideology — that the people closest to a problem are best equipped to fix it."
  • But any Republican who votes for this bill is also taking a lot of risks. They're voting for waivers from the ACA's ban on charging higher premiums to sick people, as well as waivers from the minimum benefits it requires insurers to cover.
  • They're also voting for $880 billion in Medicaid cuts over 10 years.
  • And — based on the original CBO estimate — they're voting for a bill that could cover 24 million fewer people.

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