[Update below] It's health care vote day on Capitol Hill, as House Republicans are set to vote on the American Health Care Act, their much better replacement for the Affordable Care Act (you see, AHCA has an "H" in it whereas the ACA has no "H"). Apart from making Paul Ryan's very strange late 20s kegger dreams come true, what will the bill mean for you?

In both cases, the pre-existing Obamacare and the potential Trumpcare give subsidies to people in order to help them afford private health insurance, despite what Paul Ryan told a credulous Charlie Rose about the differences between the ACA's premium support subsidies and the AHCA's premium tax credits. Language is a virus.

Speaking of viruses and the people who get them, the biggest difference between the subsidy deliveries is that the AHCA's subsidies will be based on age, whereas the ACA's are based on income. The Republican argument for this system is that its more predictable for insurers than an income-based system that fluctuated and allowed them to keep premiums high due to the fact that the ACA's subsidies rose along with insurance premiums. However, cheaper insurance for young people will come at the expense of older Americans, who insurers will be allowed to charge five times more for premiums (opposed to the ACA's three times more) for people aged 55-64.

One of the more drastic differences between the AHCA and the ACA is that it contains deep, deep cuts to Medicaid, which was expanded under the ACA and made available to people making over 133 percent of the poverty line. In order to get more conservative Republicans on board, that expansion to people making over 133 percent of the poverty line would be eliminated, and Medicaid spending would be given to states as a block grant, instead of as a federally reimbursed program. It would also allow states to set work requirements for people who receive Medicaid, including a new amendment that would require mothers who've recently given birth and use the service to find work within two months or lose access to Medicaid.

And while the elimination of the individual insurance mandate from the ACA would be gone, it's replaced with a rule that would allow insurance companies to charge 30 percent more for premiums for one year for anyone who doesn't have insurance for 63 consecutive days.

An initial Congressional Budget Office analysis of the bill showed that the rollback of Medicaid, coupled with the elimination of both the mandate that most employers provide insurance and that individuals have insurance, would cause the number of uninsured people in the country to spike. Premiums would also spike at first, according to the study, but would fall below ACA levels by 2026, at least for younger people.

The passage of the bill looked dicey in the run up to today's vote, leading to a late night session between allies of Paul Ryan and more hardline conservatives who've derided the bill as Obamacare Lite or Obamacare 2.0. The result of that negotiation was a provision of the bill that would eliminate the requirement that health insurance companies offer certain "essential benefits," which was a holdover from the ACA. Those benefits include such frivolous coverage options like pre-natal care, prescription drugs, mental health services, hospitalization and preventative care.

Despite these sweeteners, and the all-important promise (to the GOP) to stop reimbursing Planned Parenthood for treating women covered under Medicaid, there were still 36 members of the House who have indicated that they wouldn't vote for the bill as late as this morning, imperiling its passage.

Close to home, jockeying surrounding the bill has resulted in Republicans slipping a provision into the bill that would shift the funding of Medicaid from a shared burden between New York counties to the state. This move, which has picked up the name the Buffalo Bribe (despite one already kind of existing), was specifically asked for by upstate Republicans whose constituents feel it's unfair that property taxes in their counties help the state pay for Medicaid. Governor Cuomo has characterized the move as nothing more than a way to cut Medicaid funding in the state, though Democrats in the Assembly could, according to Politico, push for an income tax increase in order to keep funding the program.

Even closer to home, in the center of the universe, the city so nice they named it twice, New York, New York, Dan Donovan, the only Congressional Republican in the five boroughs, wrote an op-ed in the Staten Island Advance announcing he wouldn't vote for the AHCA. Donovan specifically cited the Buffalo Bribe, which he said would have an unfair impact on New York City due to the fact that it's exempt from the end of the cost sharing agreement, as well as the potential increase in premiums for senior citizens. He also noted that due to language in the bill which says that tax credits can't be used to buy insurance that covers abortion and contraception, the tax credits would be useless for New Yorkers due to state law that mandates insurance companies cover those two services.

President Trump, who if you recall makes just the best deals, tried putting the screws to the rebels by telling them they would probably lose their seats in 2018:

This hard sell didn't seem to work though, as Trump might have actually lost votes for the bill following his threats. And while Republican politicians spent all of 2016 solemnly intoning that they were through with Donald Trump after one snafu or another, part of what might be giving the G.O.P. rebels a little bit of backbone is the warm embrace of the Koch brothers.

Americans for Prosperity and Freedom Partners, an activism group funded by the billionaire brothers, are putting together a "seven figure" fund to support House Republicans who face primary challenges or other fundraising challenges as a result of voting against the bill. Before you start drawing hearts around pictures of the Koch brothers and making them the next Evan McMullin, note that the Kochs oppose the bill because it doesn't go far enough in repealing the ACA, especially the Medicaid expansion.

With hours to go before today's vote, protesters are still outside of Paul Ryan's office, and the bill's survival looks murky. We'll be sure to update with the vote totals when they start coming in.

[Update, 3:30 p.m.] The legislative kabuki will last at least one more day, as the vote on the bill has been totally scrapped, according to Politico's John Bresnahan: