I had breakfast and lunch with three people on staff with Republican congressmen yesterday (I am on the East Coast and one of them worked for me). And I read the summary of the bill they prepared for their congressmen. Which is what all of congress did before they voted. They told me that a small handful of conservatives drove a few small but major changes to the bill which mislead to some extent the House Republicans,, including Paul Ryan. Ryan just said the following about the bill:  “We think we need to do even more support for people who are older and also more support for people with pre-existing conditions,” Ryan acknowledged. “The Senate will complete the job.” The changes made for fewer than 12 conservatives can blow up the bill in ways not anticipated when the Republicans passed it.