The GOP health care debate has quickly become a battle of wills between the House Freedom Caucus and Republican leadership in the House and White House. And if the vote proceeds as planned on Thursday without changes to the bill, it will be a battle over reputations.

Absent a compromise between the conservative caucus and House leadership and/or the President Donald Trump and his administration, one of the two sides will emerge from Thursday’s vote significantly scathed.

“Without a doubt; it would be disingenuous to suggest otherwise,” Freedom Caucus Chairman Mark Meadows said when asked if the caucus’ hand would be weakened in future negotiations if the bill passes without conservatives’ concerns being heard.

But Meadows, who says he has a good relationship with the president, also understands that Trump’s reputation is on the line.

“Am I worried about that? The answer is yes,” the North Carolina congressman said. “Do I believe that we can find a way to get to yes and give the president a win, give moderates a win and give the Freedom Caucus and RSC a win? I believe we can.”

Trump and Speaker Paul D. Ryan have painted opposition to the measure as support for keeping the status quo of the 2010 health care law and have said on numerous occasions that failure is not an option

During a House Republican Conference meeting Tuesday, Trump outlined the potential ramifications of failure, saying that inability to pass the health care measure would derail other parts of the GOP policy agenda and would cost Republicans seats, if not their House and Senate majorities, in 2018, according to several members in attendance.

“The president was really clear. He laid it on the line for everybody,” Ryan told reporters after the conference meeting. “We made a promise, now is our time to keep that promise. And we keep our promise and the people will reward us. If we don’t keep our promise, it will be very hard to manage this.”

So far the Freedom Caucus is not relenting to such arguments.

“I’m going to be a “no’ even if it sends me home,” Meadows said, referring to the idea that his opposition could cost him re-election, although he does not see that as likely given that he feels his constituents largely oppose the bill. 

Idaho Republican Raul Labrador, one of the group’s founding members, told Roll Call that he believes leadership will ultimately realize there are more than 21 firm “no” votes and will return to the negotiating table rather than let the bill fail.

“If we cave on this then we’re going to cave on everything,” Labrador said. “They need to understand that we’re serious about this, that we’re coming to them in good faith and that we want to do what we think actually protects the president. Somehow leadership has convinced the president that this bill protects him. This bill weakens his hand because it’s going to be so unpopular a year and a half from now that people are going to be running away from the Republican Party.”

However, leadership has indicated that no further changes will made outside of the manager’s amendment released Monday and that the floor vote will proceed on Thursday.

“There is no plan to change the day of the vote,” Speaker Paul D. Ryan spokeswoman AshLee Strong said Tuesday night.

White House Press Secretary Sean Spicer, asked about the possibility of further changes to the bill during his daily briefing Tuesday, left the door open, but indicated more changes were unlikely.

“It’s possible, but I think that we’ve made some very positive steps forward, so I don’t want to rule anything out, but I will say that I feel very good about this, where it stands now,” he said. 

If the bill does fail on Thursday, both sides are ready to blame the other.

“If the Freedom Caucus kills this bill, which they could, then they will have voted to continue Obamacare,” New York Republican Chris Collins, Trump’s de facto congressional spokesman, said. “As the president pointed out, in 2018 [that] means we would probably lose the House and the Senate. If this goes down, we also won’t get the tax reform. This is do or die on Thursday.”

Collins and other members said Trump called Meadows out specifically during the conference meeting and said he was counting on him and the Freedom Caucus. According to a source in the room Trump concluded that thought by saying, “Because honestly, a loss is not acceptable folks.”

The Freedom Caucus members, however, do not see defeat of the current measure as a loss and say it’s up to leadership whether they want to put the bill on the floor Thursday without most of their members support.  

“They don’t have the votes, and if they want to put it on the floor and have it fail, that’s on them,” Freedom Caucus member Justin Amash said. “But what would really weaken our agenda is passing this bad piece of legislation, which would not improve people’s health care. And in a few years the system will still collapse and Republicans will be blamed for the collapse.”

The only way to avoid the blame game and save the reputations and credibility of Trump, Ryan and other GOP leaders, as well as members of the Freedom Caucus, is for the two sides to strike a deal they can all live with.

“There’s not a single person — well, with one or two exceptions — that want to be a ‘no,’” Meadows. “The rest of us want to be a ‘yes’ and can see a path to get there.”

That path is a policy change in the House bill — not promise of an amendment in the Senate — that would lead to a reduction in health care premiums, Meadows and other Freedom Caucus members said.

Specifically they have called for repealing the 2010 law’s requirement that insurance companies offer so-called “essential health benefits” and other insurance regulations from the current law that have driven up health care costs but they say they’re open to other options that accomplish the goal of lowering premiums.

In a sign that the White House and leadership may be open to addressing the Freedom Caucus’ concerns, Vice President Mike Pence met with Meadows Tuesday. Later that day, House Majority Whip Steve Scalise and Chief Deputy Whip Patrick McHenry had conversations with Meadows and Ohio Republican Jim Jordan.

Meadows said after those meetings that he wouldn’t characterize the negotiations as open, but that “members of the whip team are reaching out in a meaningful way and trying to figure out how we can get a consensus for all.”

Jordan, one of the founders of the Freedom Caucus and its initial chairman, said the group is not trying to show its strength by opposing the bill.

“That’s not how I view it,” he said. “I view it as we got to do what’s consistent with what we told the American people, and this bill doesn’t do that. And it’s that simple. It’s really that basic.”

Arizona Republican Trent Franks said sarcastically that the Freedom Caucus was risking “disaster and cataclysmic collapse” by taking their opposition this far.

“Of course we are. Isn’t that obvious?” he said. “But we’re doing it for the cause of human freedom in our own hearts and so it’s sort of hard to dissuade us from that.”

— John T. Bennett contributed to this report.