Since Republicans unveiled their new health-care proposal on March 7, it's been criticized by politicians on both ends of the political spectrum. The Fix's Amber Phillips and Aaron Blake explain why the GOP is struggling to come up with a plan everyone likes. (Peter Stevenson/The Washington Post)

Paul Kane, The Post's lead congressional reporter, is a legendary emailer. His emails, which I have been lucky enough to have received more than a decade, are smart, funny and deeply insightful. Before I leave The Post for good next Friday, PK and I did one last email exchange — this one on the fate of the the Republican health-care legislation, and the broader dynamic between President Trump, House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell. Our unedited conversation is below.

FIX: Okay, PK. Paul Ryan is now open to changing the health-care bill on the House floor — days after he said that any changes would likely kill the bill.

Why the change? Is it as simple as the bill is in trouble and Ryan gets that the only way to save it is to change it?  Or was this always part of the negotiating strategy?

PK: So this is one of those almost Clintonian-like situations in which we have to definition the definition of "is," except now we must define "changes." It's still not clear how vast and wide the changes are that Ryan and his leadership team are willing to undergo to the bill. My reporting this week has shown that this is not the old Paul Ryan of his Budget Committee days, dialing up aspirational outlines of fiscal austerity that he had the luxury of knowing would go nowhere with Obama in the Oval Office.

This proposal was crafted trying to thread a needle between two competing corners of the House GOP Conference: the far-right blockade and a much larger, less vocal crowd from states where their governors accepted the expanded Medicaid provision in the 2010 ACA. Some Freedom Caucus folks have been strenuously opposed to the proposed tax credits for purchasing insurance, saying it's a new form of entitlement, and many want to more quickly phase out the Medicaid expansion.

The American Health Care Act falls far short of repealing and replacing the Affordable Care Act, but there are some big potential changes. (Daron Taylor/The Washington Post)

But what I'm hearing is that the group of "hell-no" votes on the right over these issues is nowhere near as many as those Republicans from states like New York, Ohio, Colorado, where there's been the Medicaid expansion and these GOP lawmakers can't just vote to expel millions of people from having insurance without a backstop.

The real belief, inside Republican leadership offices, is that the conservative griping is ultimately a political problem, not a policy problem, and the one person who can truly resolve the political problem on the right is ... President Donald J. Trump.

If Trump ever fully leans into this legislation, giving it the full-forced endorsement that he's proven capable of on other issues, Ryan and House GOP leaders believe that the conservative opposition will dissolve quickly.

Think of it this way: We in the media went crazy over that CBO score showing 24 million losing insurance over almost the next decade, but the underlying numbers were good for those far-right conservatives, real deficit savings and lower premiums.

But Trump simply has not yet fully bought into this health-care legislation. Sure, Tom Price is doing CNN town halls and VP Pence is saying all the right things, and there's an occasional tweet here or there about the issue from Trump. But it's clear as day the president has not yet leaned in — go read that dispatch from our amazing colleague Abby Phillip from Nashville. Took Trump 25 minutes to even mention health care.

This is what's preventing Republicans from closing the deal.

FIX: That’s super interesting to me. I annotated Trump’s interview with Tucker Carlson from Wednesday night and was struck by the fact that not once but twice he said he wouldn’t sign any bill that “didn’t take care of our people.”

That’s obviously very vague. But veto threats even as Ryan and the rest of Republican leadership are trying like hell to thread that needle can’t be a fun for the speaker. Which brings me to a broader question: What, really, is the relationship between Ryan and Trump?

In that same interview with Tucker, here’s what Trump said: “I like him. We had our run-ins, as you probably have heard, initially. But I think he is very much — he wants to do the right thing.  That I believe 100 percent.”

Ryan seems to be bending over backward of late to emphasize Trump is a good guy who is super involved and behind this bill.

Speaker of the House Paul Ryan (R-Wis.) told reporters, March 16, that he is working closely with President Trump on health-care legislation. (Reuters)

How much of all of this is just posturing? Or is there a genuine relationship there?

PK: It’s way too soon to say whether there’s a real relationship growing there. Way too soon, and the success (or failure) down the road will likely determine that relationship. Think of it this way, at this point in 2009, Harry Reid and Obama did not have much of a relationship. Sure, Obama had served in the Senate, for just two years, really, then left to run for president, and yes, Reid encouraged him to run — but Reid encouraged everyone to run. They didn’t truly develop their bond until they walked through the fires of passing Obamacare, Dodd-Frank and then playing defense against the insurgent Republicans from 2011 to 2016, becoming truly close allies and, in a way, friends.

Trump and Ryan begin their relationship in a place of even less trust, considering their battles in 2016. Some politicians let bygones be bygones if they win ([Chuck] Schumer is very much like this; he wins, there’s no grudge held, it’s water under the bridge). Trump strikes me as someone who holds grudges, but I’m not certain.

So that’s one of the reasons why this initial health-care dance is so important. They both realize that they need each other to get things done, and if they can be successful in this early bout, it is something to build on down the line for tax reform, infrastructure and other big initiatives.

But if this disintegrates, if there’s no repeal of Obamacare, it’s bad, very bad, for both men — and what it does to their relationship for the next few years.

It’s early, for sure, and there’s plenty of time to right this ship. But if things keep getting worse on passing the Ryan health bill, and Trump’s allies decide to place all the blame on him, then it really makes it more difficult to do things farther down the road.

FIX: And where does McConnell stand in all of this?  It feels like he is in charge of the more fractious side of Congress — smaller margin for error with only 52 seats and more senators willing to buck Trump. Obviously McConnell is back of the mind right now because the fight in in the House. But how much of the calculations being made by vulnerable House members on this bill is based on whether or not it is going to go somewhere in the Senate? I assume the last thing a targeted House GOPer wants is to vote for a tough bill like this one and watch it die without a vote in the Senate.

So, how much reassuring is McConnell doing?

PK: Emotional reassurance is just not in Mitch McConnell's DNA.

Just not something he does on a personal or professional level. Period. Right now, McConnell is waiting to see what Ryan can do, and if Ryan can deliver him a product, then he's ready to see whatever he can do to pass another product. McConnell is well aware that his bloc of moderates/mainstream conservatives/senators from Medicaid-expansion states simply won't tolerate the current draft of the House legislation. That's a nonstarter, and McConnell knows it. The long game here, I am hearing, is to try to set up a House-Senate conference that works out the differences between the two bills, and that conference could be "meeting" for quite some time throughout the spring — assuming that the House and Senate actually pass their versions of the legislation.

All in all, so few of the old rules apply anymore. We both came of age in the era of BTU/cap-and-trade, when House Democrats mistakenly pushed liberal energy legislation that never had a chance in the Senate, and those House Democrats were hung out to dry in the next general election. I'm reliably told that, now, most House Republicans are more afraid of not approving a bill to repeal Obamacare, any bill to repeal Obamacare, regardless of its fate in the Senate, than to simply do nothing.

They'd rather vote for something repealing Obamacare, even if it never gets a Senate vote, than risk ending up facing a conservative primary challenger accusing them of doing nothing to repeal Obamacare.

Do those folks add up to a bare majority to pass this health law? Probably not, at least not at the moment, which is why you need to add in some measure of moderate Tuesday Group types and more Freedom Caucus types.

FIX: That last part is so intriguing to me. I had been comparing this vote to cap and trade — apparently wrongly!

I think it gets to the broader reality of politics — especially in the House — these days: The only real danger is in pissing off your base. The way the districts are drawn, the way the funding mechanisms of campaigns now work, the activism of the two bases of the parties — it all pushes members to the extreme. They now act almost entirely at the behest of their base rather than what they believe is the right thing for the country.

I’m not so naïve as to believe politicians haven’t been acting in their self interest since time immemorial, but it feels more transparent and transactional now than ever before. Or maybe I am just getting older?

Anywho….

Last question: What’s your prediction for where this bill goes. Can some version pass the House, Senate and a conference committee? Or is it already too weighed down by doubts from within the GOP to trudge all the way to the legislative end?

PK: Last question first. Trump needs to be more aggressive — himself, not just his Cabinet — and that can get enough votes on the right, giving Ryan (maybe) just enough to get this through the House. In the Senate, McConnell has to come up with his own bill that will tilt more friendly to the [Rob]Portman/[Shelley Moore] Capito crowd, which might upset Ted Cruz and Mike Lee, but I'm still not certain that in the end Cruz is willing to be the guy who blocks Donald Trump's first big initiative.

That still only gets me to a conference committee — from there I don't know how they can bridge the divide. I just don't know. Maybe, but it's hard to see.

To your first point: today's politics. I think the two worst character traits in today's Congress are fear and contentment. You're right about the way that the districts are drawn and making it a safer, easier play to line up with your base.

But that doesn't mean you have to always play to your base. There's plenty of room for lawmakers to engage in the big issues, try to forge consensus, fight for what they believe is the right outcome. You just have to be willing to work hard, willing to go home as much as possible to explain yourself and to run a really disciplined, well-funded campaign if you get a primary. Folks like Lamar Alexander, Lindsey Graham, Tom Cole, Jack Reed, Frank Pallone — these are are all people who've done more than their fair share of bipartisan deals in the Senate and House. Some have faced down tough primary elections.

They're all still here.

The "contentment" character trait is that too many lawmakers are content with what they have: a tiny fiefdom. They'd rather not rock the boat because that means they might have to work really hard to win reelection. That's a terrible way to go about life in Congress. These jobs aren't worth a thing if you're not going to get in the mix and try to do big things.

You and I have spent 14 of the last 16 years together as co-workers, first at Roll Call and for the past decade at The Post. We've done some great things together — whether it was breaking the John Ensign/affair story or writing the first national piece examining how Steve "Gospel Singing Farmer From Frog Jump" Fincher might be the emblematic 2010 recruit of a coming wave election.

The biggest change that I've seen over those years is the shrinking number of leaders on Capitol Hill; not the actual elected leaders, but the men and women in the rank and file who commanded the policy brigade and through the sheer force of their character made themselves players. They weren't afraid, and they weren't content.

I can't believe this is our last email exchange, Chris, because this issue is gonna keep on going and going. What you've done with The Fix is nothing short of amazing, a political watering hole for millions of readers every day to learn what is happening and why it's going in that direction.

Our earliest days together at Roll Call began with you covering a sleepy little primary on Chicago's North Side to replace Rod Blagojevich, while Mark Preston and I covered the last years of Tom Daschle's Senate reign. By 2009 those worlds converged in the West Wing as Rahm, having left the House, and Daschle's acolytes took charge of Obama's presidency.

I sure hope there are some other young reporters out there right now who are beginning to have the same experience that we all had.

Have fun with Preston at CNN, buddy. As Springsteen said: "Grab your tickets and your suitcase, thunder's rolling down the tracks, you don't know where you're goin' now, but you know you won't be back."

See you in the land of hope and dreams, my friend.