House Republicans near potential breakthrough on health care, source says

By MJ Lee, Deirdre Walsh and Lauren Fox CNN

(CNN) -- Top House Republicans may be nearing a significant breakthrough among some key players on efforts to repeal and replace Obamacare, one month after a Republican health care bill was pulled from the House floor.

Conservative House Freedom Caucus chairman Mark Meadow and moderate Tuesday Group leader Tom MacArthur are working toward a deal that could bring 18-20 new \"Yes\" votes from the conference's conservative wing, according to a source familiar with the talks. But it's not clear there would be enough votes in the broader GOP House conference to pass the bill.

The White House and GOP leadership have been involved in the talks and are aware of the latest progress, the source added.

GOP Rep. Tom Cole, who supported the Republican health care legislation known as the American Health Care Act, has been in touch with his colleagues in the House as well as the White House about health care over Congress' two-week recess, which wraps next week. His big-picture takeaway on the discussions: \"Differences have narrowed and this thing is very much alive.\"

But in a phone interview with CNN Thursday morning, Cole also cautioned that there are a lot of mixed feelings across the conference among members and aides on whether this effort could be any more successful than the first time.

\"It's amazing the diverse things you hear from different people,\" Cole said ranging from, \"'It's hopeless' to 'Oh, it's going to get there.'\"

The colleagues he has spoken with appear \"cautiously optimistic,\" Cole added. \"Some of the folks in leadership -- they've been burned so many times they're afraid to be optimistic,\" he said.

As of now, the broader conference is not aware of what the new health care blueprint is, suggesting that things are very much in the air. \"I think only the people directly involved in the talks have a very clear idea of what's happening,\" Cole said.

A Republican member familiar with the negotiations expressed some skepticism that the Freedom Caucus can actually deliver the votes they are promising.

\"They have yet another agreement in principle, but no final legislative language,\" the member told CNN. \"We have no idea if this nets us votes or can pass the Byrd Rule,\" a reference to whether the current bill would be eligible to pass via reconciliation, which would only need a simple majority to pass in the Senate, as oppose to needing to clear 60-vote threshold.

The member added, \"I would say we are skeptical at best.\"

In a speech in London on Wednesday, House Speaker Paul Ryan said that \"health care is not dead.\"

Ryan said he and others are working on \"finishing touches\" to their repeal and replace legislation, though he also acknowledged that this work is \"difficult.\"

In the past few weeks, the White House has been making a strong push take one more stab on health care, particularly as President Donald Trump approaches his 100-day mark in office.

But there are significant obstacles.

The focus next week will be to passing a bill to avoid a government shutdown, so it is unclear how much members will be able to focus on getting another health care vote in the House.

And there are serious philosophical divides between the House's more moderate and conservative members.

Meadows and his colleagues on the Freedom Caucus want to get at as many of Obamacare's Title One regulations as possible. MacArthur and his fellow moderates want to ensure that key protections in the law are not gutted.

The talks between Meadows and MacArthur have continued to focus on three areas identified before the congressional recess: essential health benefits, community rating and guaranteed issue, according to sources. The work has centered on what the triggers would be for states to opt out of those regulations and how much money could be added to the bill to address concerns that the regulations would essentially undercut the existing ban on insurers discriminating on the basis of pre-existing conditions.

TM & © 2017 Cable News Network, Inc., a Time Warner Company. All rights reserved.