By LINDSEY McPHERSON and REMA RAHMAN/CQ ROLL CALL

The GOP health care bill appears poised for failure with at least 19 Republicans committed to voting “no,” absent additional substantial changes, and several more likely to join them in opposition. 

This reality seems to be sinking in with GOP leaders, as they have started discussions with the House Freedom Caucus that accounts for most of the current opposition to the bill. However, neither leadership, nor the Freedom Caucus would say serious negotiations about changes were underway Tuesday night.

House Majority Whip Steve Scalise told reporters that the changes released in the manager’s amendment Monday “got a number of members to move to yes,” but he suggested they’re still short of the 216 votes needed to pass the bill.

 “We’re moving the right way, and we’re not stopping,” he said.

CQ Roll Call has confirmed in interviews and review of public statements that at least 19 Republicans will not vote for the GOP health care bill Thursday. Another handful said they were either undecided or were leaning toward opposing the bill, with most of those members still looking for changes. If the number of “no” votes surpasses 21, that’s enough to sink the bill.

Asked if negotiations are closed at this point, Scalise said, “We’re having a lot of conversations right now.”

The accumulation of the “no” votes came on the same day President Donald Trump met with the GOP conference to advocate for passing the bill — or else face losing their seats in 2018.

Members who oppose the latest version of the bill — complete with a manager’s amendment released late Monday to appease some conservatives — continued to express a host of issues with the measure.

GOP Iowa Rep. Rod Blum said on Twitter the bill in its current form did not do enough to drive down premiums, a view shared by most of his fellow Freedom Caucus members.

#AHCA doesn’t do enough to lower premiums for hardworking Americans. I’m a “no” on current version – need to drive down actual costs! #IA01

— Congressman Rod Blum (@RepRodBlum) March 21, 2017

New Jersey Republican Leonard Lance, a member of the more moderate Tuesday Group, said after meeting with the president Tuesday he wanted to move forward on a repeal and replace plan, but “I don’t think that this bill is sufficient to do that.”

Arizona Rep. Paul Gosar’s “no” vote is so firm he slipped his cellphone out of his suit pocket when answering questions from reporters in the Speaker’s Lobby Tuesday about where he stood and whether he had gotten any pushback from leadership.

“My phone hasn’t rung,” Gosar, a Freedom Caucus member, said. “That’s how clear I am about this.”

But don’t yet count out the operation to get the bill to pass.

House Freedom Caucus Chairman Mark Meadows told reporters he met with Vice President Mike Pence and his staff Tuesday afternoon and later had separate conversations with Scalise and Chief Deputy Whip Patrick McHenry. Scalise and McHenry also spoke with Ohio Republican Jim Jordan, the former Freedom Caucus chairman.

“There are some things that definitely don’t move the ball forward, but I welcome any conversations and am willing to engage in those conversations in a good faith way,” Meadows said.  

The North Carolina Republican said both sides have been coming with “creative ways” to get the “no” votes to a “yes,” but he declined to specify what those were.

 Meadows also declined to characterize the negotiations as open.

“I’ve found 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,” Meadows said.

The Freedom Caucus specifically is pushing for repeal of 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.

 “Anything else that is a different way to lower premiums in a different way gets me to ‘yes,’” Meadows said.

Meadows cited the “very aggressive whip operation” as an indication that the leadership’s whip count, like the Freedom Caucus’s count, is short of 216. Asked if the vote will still occur on Thursday, Meadows said, “They’re telling me it is, regardless of whether they have the votes or not is what they’re saying.”

Speaker Paul D. Ryan spokeswoman AshLee Strong said there is no plan to change the day of the vote.

— Kerry Young, Erin Mershon and Joe Williams contributed to this report.