House Speaker Paul Ryan of Wisconsin, accompanied by Rep. Cathy McMorris Rodgers, R-Wash., right, speaks at a news conference following a GOP party conference at the Capitol in Washington, March 15, 2017.
House Speaker Paul Ryan of Wisconsin, accompanied by Rep. Cathy McMorris Rodgers, R-Wash., right, speaks at a news conference following a GOP party conference at the Capitol in Washington, March 15, 2017.

WASHINGTON - Their health care overhaul imperiled from all sides, the White House and top House Republicans acknowledged Wednesday that they would change the legislation in hopes of nailing down votes and pushing the party's showpiece bill through the chamber soon.

Speaker Paul Ryan of Wisconsin declined to commit to bringing the measure to the House floor next week, a fresh indication of uncertainty. Republican leaders have repeatedly said that was their schedule, but opposition mushroomed after a congressional report concluded this week that the measure would strip 24 million people of coverage in a decade.

Ryan told reporters that GOP leaders could now make "some necessary improvements and refinements" to the legislation, reflecting an urgency to buttress support. The measure would strike down much of former President Barack Obama's 2010 overhaul and reduce the federal role, including financing, for health care consumers; Democrats uniformly oppose it.

FILE - Vice President Mike Pence arrives on Capito
Vice President Mike Pence arrives on Capitol Hill in Washington for a Senate Republican strategy session, March 14, 2017. On March 15, Pence sought to rally support among House Republicans for the party's health care overhaul.

At an all-hands meeting Wednesday evening of House GOP lawmakers, Vice President Mike Pence and party leaders urged their rank and file to rally behind the legislation.

"It's our job to get it out of here and get it to the Senate,"' Pence told the Republicans, according to Representative Dennis Ross of Florida. That would let President Donald Trump pressure "Democrats in these red states to come on board,"' Ross said, referring to Republican-leaning states where Democratic senators face re-election next year.

Price calls governors

Health Secretary Tom Price was using phone calls to lobby Republican governors, some of whom — with home-state GOP members of Congress — oppose the bill's phase-out of Obama's expansion of Medicaid to 11 million additional lower-income Americans.

Amid the maneuvering, a government report said more than 12 million people have signed up for coverage this year under the very statute that Trump and congressional Republicans want to repeal. That figure underscored the potential political impact of the GOP's next move.

Pence met repeatedly with House Republicans, but rebels still abounded. Conservatives were unhappy the measure doesn't erase enough of Obama's law, while at the other end of the party's spectrum, moderates were upset the bill would strip millions of health coverage.

"Oh, heck, yes," said one conservative leader, Representative Jim Jordan of Ohio, when asked whether the GOP legislation needed changes to win his support.

Conservatives want to end the Medicaid expansion next year, not in 2020 as the bill proposes. They say a GOP proposed tax credit to help people pay medical costs is too generous, and they want to terminate all of Obama's insurance requirements, including mandatory coverage of specified services such as drug counseling.

Moderates' objections

Moderates, however, feel the tax credits are too stingy, especially for low earners and older people. They oppose accelerating the phase-out of the Medicaid expansion and are unhappy with long-term cuts the measure would inflict on the entire program.

Terminating the Medicaid expansion in 2020 and not 2018 "is sacrosanct to me," said moderate Representative Tom MacArthur of New Jersey.

Senate Judiciary Committee Chairman Chuck Grassley
FILE - Senator Chuck Grassley, an Iowa Republican, is pictured April 11, 2016. Grassley said March 15, 2017, that the proposed Republican health care overhaul lacked the votes to pass in the Senate.

In a new complication, Senator Charles Grassley, an Iowa Republican, said the measure lacked the votes to pass in the Senate, where Republicans hold a precarious 52-48 majority. That left House members angry about being asked to take a politically risky vote for legislation likely to be significantly altered.

Moderates "don't like the idea of taking a vote in the House that may go nowhere in the Senate," said Pennsylvania Republican Representative Charlie Dent.

Pence told House conservatives earlier that the administration was open to changes.

"He gave us a lot of hope," said Representative Mark Walker of North Carolina, a conservative leader.

The bill would enfeeble Obama's individual mandate, the requirement that Americans buy coverage, by abolishing the tax fine on violators. It would end subsidies that help low-income people with high insurance premiums the most and replace them with tax credits that are bigger for older people. It would cut Medicaid, repeal the law's tax increases on higher-earning Americans and require 30 percent higher premiums for consumers who let coverage lapse.

Coverage, costs

GOP support became scarcer when the nonpartisan Congressional Budget Office projected the legislation would push 24 million Americans off coverage in a decade and shift out-of-pocket costs toward lower-income, older people. That's 4 million more than the 20 million who've gained either Medicaid or insurance coverage under Obama's law.

Hundreds of conservative activists rallied outside the Capitol in subfreezing weather to call on congressional leaders and Trump to abandon the GOP bill and fully repeal Obama's law. The rally was organized by FreedomWorks, a conservative group backed by the billionaire Koch brothers.

The latest government sign-up numbers missed Obama's target of 13.8 million people for 2017. But experts said the report undercuts Republican claims that the health law's insurance markets are teetering toward collapse, which they say makes repealing the law crucial.