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The White House stepped up its push on Tuesday to revive legislation to repeal the Affordable Care Act by placating the most conservative House members, but the effort risked alienating more moderate Republicans whose votes President Trump needs just as much. Vice President Mike Pence met for about two hours on Tuesday night with lawmakers, including leaders of three groups of House Republicans. But lawmakers leaving the conclave in the basement of the Capitol said that no deal had been reached and that talks would continue on Wednesday. (Pear and Kaplan, 4/4)

The lack of a resolution complicates a White House push for a House vote on a healthcare proposal before Friday, when lawmakers return to their districts for two weeks. “Good talk, good progress,” Pence told reporters without providing details. Freedom Caucus leader Mark Meadows said the meeting had focused on an amendment to create a "backstop" to ensure individuals with chronic illnesses in high-risk pools do not see spikes in insurance premium costs if other aspects of Obamacare, also known as the 2010 Affordable Care Act, are repealed. (Morgan and Abutaleb, 4/5)

The crux of the new proposal would be to allow states to seek exemptions from certain mandates established under the Affordable Care Act — including a requirement that insurers cover 10 “essential health benefits” as well as a prohibition on charging those with preexisting medical conditions more than the healthy. While the largely behind-the-scenes effort generated optimistic talk, no clear path has emerged toward House passage of the Republican bill. On Tuesday evening, key players said they were still waiting to see new proposals in writing, and some lawmakers said they were wary of rushing the process. (DeBonis and Wagner, 4/4)

Conservatives’ latest Obamacare repeal proposal amounts to a sneak attack on one of the health care law’s most popular safeguards for people with pre-existing conditions. White House officials and members of the House Freedom Caucus are discussing giving states the option of a waiver from a key Obamacare protection — called community rating — as part of their last-ditch effort to revive the repeal effort. (Haberkorn, 4/4)

Pence told hard-line Freedom Caucus members Monday night that changes to the bill would allow governors to opt out of Obamacare’s “community rating” provision, which prohibits insurers from charging higher premiums to people who are sick, are older or based on their gender. Without it, insurers could charge more to people with cancer or other medical conditions, though supporters say it would drive down premiums for healthy people. Meadows said they were told governors would be allowed to opt out for “all community ratings with the exception of gender. ”But moderate GOP members who met with Pence the same day say they were under the impression that governors would only receive “community rating” flexibility based on a person’s age — not their illness or other factors. (Bade and Dawsey, 4/5)

But the attempt to move the bill further to the right threatens to erode support among moderate members who were turned off by the previous version of the American Health Care Act. “While we haven’t picked up any votes yet, this concept is already showing signs of losing a ton of them,” a senior Republican source said. (Sullivan and Hellmann, 4/4)

At the White House, Pence said he and President Donald Trump "remain confident that working with the Congress we will repeal and replace Obamacare. "But there was no evidence that the proposal won over any GOP opponents who'd forced Trump and party leaders to beat an unceremonious retreat on their bill on March 24, when they canceled a House vote that was doomed to failure. (Fram, 4/4)

[C]hances remain slim that Republican leaders can build consensus among the GOP factions — the conservative House Freedom Caucus and more centrist Tuesday Group — that doomed the last effort. House Speaker Paul D. Ryan (R-Wis.) lowered expectations that a deal could be struck soon. “Look, the president would like to see this done,” White House Press Secretary Sean Spicer told reporters during an off-camera briefing Tuesday. “I'm not going to raise expectations,” Spicer said. “But I think that there are more and more people coming to the table with more and more ideas about [how] to grow that vote.” (Mascaro and Bierman, 4/4)

House Speaker Paul D. Ryan on Tuesday cast doubt on the possibility that the chamber would vote this week on a revised bill to repeal and replace the 2010 health law. While the Wisconsin Republican noted there are ongoing conversations among lawmakers regarding potential changes to the legislation (HR 1628), he cautioned that those discussions were still in the conceptual stage. “We don’t have bill text or an agreement yet, but these are the kinds of conversations we want,” Ryan told reporters following a closed-door House GOP conference meeting. “That is not to say that we are ready to go because we want to make sure that when we go we have the votes to pass this bill.” (Williams, 4/4)

When asked if there will be a health vote by the end of the week, Ryan said he didn’t know. “I don’t want to put some kind of artificial deadline because we’re at that conceptual stage,” Ryan said. “We have very productive conversations occurring with our members. But those are productive conversations; it doesn’t mean we have language and text that’s ready to go and the votes are lined up.” (Wong, 4/4)

Even if members of the Freedom Caucus were to reach an agreement with the administration, GOP leaders would still need to shore up support among more centrist House Republicans who have objected to some of the changes sought by conservatives. “That would not move me to the ‘yes’ column,” said Rep. Leonard Lance (R., N.J.), who said he favored retaining the requirement that most insurers offer specific health benefits such as maternity care or hospitalization. (Peterson and Andrews, 4/5)

Jim Renacci, a Republican member of the Ways and Means Committee, had supported the previous version of the measure, which was pulled from a floor vote, despite some reservations about its contents. Now he says he’s withholding support until he sees the outlines of the most recent changes, which were presented to some members Monday night by Vice President Mike Pence. “I’m a big believer in the process, I’m a big believer in hearings, I’m a big believer in having the authorizing committees to have the opportunities, as well as members from outside, to hear what’s going on, and that process will actually bring a better resolution,” Renacci said. “We have actually broken that process, with no hearings.” (Edgerton and House, 4/4)

White House officials privately said they don't expect a deal anytime soon on health care. That’s despite direct entreaties from some of the White House’s heaviest hitters — Vice President Mike Pence, chief of staff Reince Priebus and budget director Mick Mulvaney — who are darting between the Capitol and the West Wing to meet with conservatives and centrists to test the chances for reviving the so-called American Health Care Act. (Cheney, Bade and Dawsey, 4/4)

Republicans have little space on the calendar to hold a new vote this month. They are scheduled to begin a two-week recess on Friday, and when they return they will have five days to pass a spending measure to keep the government funded after April 28. (Edgerton, John, House and Sink, 4/4)

The same firebrand conservatives who helped derail the GOP's long-awaited legislation to repeal and replace key parts of the Affordable Care Act are now trying to breathe new life into the bill with a long shot effort to bring it back for a vote in May. Or at least keep it on life support through the two-week April recess when they'll otherwise have to explain the bill's derailment back home. "We're on the eve of going home and spending two weeks with our constituents ... and they know they're going to get questions about this," said Rep. Steve Womack, R-Ark. "And for the people who were 'no' they'll have justification to deal with." (Davis, 4/4)

Powerful health industry groups shut out of the first failed GOP Obamacare repeal effort say the second version will collapse even faster. (Cancryn and Demko, 4/4)

Shares of U.S. hospital operators dropped on Tuesday as Republicans sought to revive plans to dismantle the Affordable Care Act that has benefited the companies. Shares of HCA Holdings, the largest publicly traded hospital operator, fell 3.2 percent, while Tenet Healthcare was off 4.8 percent and Community Health Systems dropped 6.3 percent. (Krauskopf, 4/4)