Republican leaders are trying to bridge the divide on their bill to alter the Affordable Care Act. NPR’s Ron Elving explains the options available to them, and the potential consequences of failure.

KELLY MCEVERS, HOST:

And to help us understand what’s happening on Capitol Hill tonight, I am joined by NPR’s Ron Elving. Hello there, Ron.

RON ELVING, BYLINE: Good to be with you, Kelly.

MCEVERS: So tonight the president threatened that if the House does not vote on this tomorrow and does not pass their own health care bill, that he is going to move on and leave Obamacare in place. How serious a threat is that do you think?

ELVING: It sounds pretty serious. It is certainly an escalation in the war of words over all this. But you know, if you’ve read “The Art Of The Deal,” you know that Donald Trump is not averse to the art of the bluff. So we don’t know. Would he really be willing to walk away from the entire issue of health care and the entire promise that he made and the entire Republican Party has been making for the last seven years to repeal Obamacare and replace it? One wonders.

MCEVERS: I mean what are the options right now for House Speaker Paul Ryan to get this thing done?

ELVING: It looks as though the plan, since the president has sent Mick Mulvaney, former House member and now the OMB director, director of the president’s budget office…

MCEVERS: Right.

ELVING: …To say on his behalf, OK, we’re done negotiating. We’ve got a deal as far as we’re concerned. You guys vote on it tomorrow. And it appears to be stripping out the essential health benefits package – this is 10 things that include maternity care and so on – saying, no longer will that be required. That will be up to individual consumers and insurance companies to negotiate. They get rid of that. That lowers costs, and that makes them happy perhaps. Although, they’re still asking for an ironclad guarantee that people’s premiums will go down – a tough one.

And if they are happy – if the House Freedom Caucus is happy and you get those last 25, 30 people on board, then the moderates probably will get rolled tomorrow, and they will actually pass something if all those things are true and if the moderates are rolled. And then they’ll go to the Senate, which will not consider the bill in its current form. It will not consider a bill without the essential health benefits package.

MCEVERS: Right, right. So in order to get this passed the House, they’re going to pass a thing that the Senate will very likely not pass. That’s what’s going on. So if you’re President Trump, like, what’s your calculus then?

ELVING: Calculus is that once you’ve gotten a bill through the House, there’s just one more chamber to go. And even if they pass something quite different – distinctly different, then you come back to the House and say, you have to conference with the Senate. You guys get together in a big conference committee. Everything’s on the table. Nothing is set in stone until everything is agreed upon.

You negotiate that out with a lot of help from the White House, no doubt. And then we’ll take it back to both chambers and twist some arms and incentivize people and threaten to walk away and say we’re going to stick you all with Obamacare and say whatever you need to say to get the deal done sometime – weeks, months – from now but before August recess if at all possible.

MCEVERS: Right, so the way things usually get done in Washington then, yeah.

ELVING: That would be true, especially when you’re moving a sixth of the national economy and changing something that has been such an emblem for the Republican Party and for the Trump candidacy.

MCEVERS: Let’s talk about if this fails in the House. I mean what are the consequences for Paul Ryan if that happens?

ELVING: That is a stickier proposition. Paul Ryan has really invested all of his speakership in getting this done and done in the way that he wants to have it done. He has brought to this all his intellectual energy, all the things he has tried to do as a member of Congress, as chairman of the Ways and Means Committee. He is all in on this bill. If they can’t get it through the House, they will have to go back to the drawing board and try further maybe without a lot of help from the president. Maybe that will be a facilitator. Maybe it will be a deal killer.

But if the bill goes down tomorrow – and I’m not saying that it will. If the bill goes down tomorrow, then Paul Ryan is really left with few options of any kind, let alone any good ones. And he may actually have to truly start over from scratch and push this whole issue down the road months and try to turn to something else like tax reform.

MCEVERS: That’s NPR’s Ron Elving talking about what’s going on in Capitol Hill tonight with the Republicans’ health care plan. Thank you so much, Ron.

ELVING: Thank you, Kelly.

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