The upshot is that Trump, Ryan and other GOP leaders are dealing with a legislative balloon — whenever they push on one side, it pops out somewhere else. Every concession or revision they make has the potential to cause more problems for the other end of the conference.

White House officials and Republican leaders remain optimistic that they will get the 215 votes they need, but it will very tight.

Hours after being singled out by Trump over his opposition to the Republican health care plan, Freedom Caucus Chairman Mark Meadows said his group of conservatives still have the votes to block the bill. Freedom Caucus insiders say the group has 27 members who are firmly against it or leaning “no.”

House GOP leaders can only afford to lose 22 members on the bill.