In this March 8, 2017, photo, House Speaker Paul Ryan of Wis. speaks during a news conference at the Republican National Committee Headquarters on Capitol Hill in Washington. House Republicans are working on a companion to their bill replacing “Obamacare,” a legislative second act that would ease cross-state sale of health insurance and limit jury awards for pain and suffering in malpractice lawsuits. The problem: the so-called “sidecar” bill lacks the votes in the Senate. (AP Photo/J. Scott Applewhite)
In this March 8, 2017, photo, House Speaker Paul Ryan of Wis. speaks during a news conference at the Republican National Committee Headquarters on Capitol Hill in Washington. House Republicans are working on a companion to their bill replacing “Obamacare,” a legislative second act that would ease cross-state sale of health insurance and limit jury awards for pain and suffering in malpractice lawsuits. The problem: the so-called “sidecar” bill lacks the votes in the Senate. (AP Photo/J. Scott Applewhite) Credit: J. Scott Applewhite

Washington — House Speaker Paul Ryan said on Wednesday that his health care proposal must change to pass the House, marking a significant retreat from his earlier position that the carefully crafted legislation would fail if substantially altered.

Ryan acknowledged that changes would be made two days after an analysis issued by the Congressional Budget Office prompted a fresh round of criticism of his proposal. Among the report’s projections was that 14 million fewer Americans would be insured after one year under the Republican plan.

Speaking after a private meeting of GOP lawmakers, Ryan said leaders would “incorporate feedback” from the rank-and-file in response to the CBO findings. He did not repeat his previous comments calling support for the bill a “binary choice” for Republican lawmakers.

“Now that we have our score we can make some necessary improvements and refinements to the bill,” he said, referring to the CBO’s estimate of the impact on the number of those covered by health insurance and what the GOP proposal would cost.

Ryan did not detail what changes are under consideration to his plan.

Vice President Mike Pence also spoke to House Republicans in the meeting, acknowledging that the White House was open to changes in the legislation, which heads to the House Budget Committee for approval Thursday. President Donald Trump has offered his support for Ryan’s measure, while still meeting with conservative lawmakers who have expressed serious doubts about the plan.

“This president is ready to put the full weight of his bully pulpit and all of his tools” behind the bill, Pence told Republicans, according to Rep. Kevin Cramer, R-N.D. “It was very important for us to hear that, because there are a lot of people who need that shoring up.”

Earlier in the day, Pence told conservatives at a private lunch meeting of the Republican Study Committee, a large caucus of conservative House Republicans, that the plan was still under negotiation, according to several attendees.

“As he said, it’s not often that we get an opportunity to undo such a big piece of legislation that had negative consequences on the American people,” said Rep. Markwayne Mullin, R-Okla., paraphrasing Pence’s message. “He’s open to make improvements. … Anything that can get 218 votes and make the bill better, we’re all about it.”

Pence’s visit to Capitol Hill — which included meetings with influential blocs of Republicans, as well as individual members — came as part of a White House effort to salvage support for the embattled American Health Care Act, even as Trump’s conservative allies told him the bill could be a political trap.

Ryan aides downplayed his remarks, saying that the speaker had long acknowledged further changes were possible as the bill moved through a multistep legislative process.

“As the speaker has repeatedly said, this bill will work its way through regular order and while the structure will remain intact, modifications will happen during the legislating process,” spokeswoman AshLee Strong said. “But the reality remains: members will face a binary choice to either vote for a bill that can pass or vote for Obamacare status quo.”

The legislation will face an important test Thursday, when the Budget Committee will decide whether advance it to the House floor. The committee may not directly amend the bill but may make non-binding recommendations. Any substantive changes would be made by the House Rules Committee, which controls how the bill is presented and debated on the floor.

House Budget Committee Chairman Diane Black, R-Tenn., insisted that GOP leaders are not “dug in” when it comes to concerns about the measure.

“We’re listening; we’re definitely listening,” she said on Wednesday to the conservative radio host Hugh Hewitt. “And I will tell you: Tune in to our Budget Committee tomorrow, and you will hear these conversations.”

The blitz came two days after the CBO estimated that 24 million fewer Americans would be insured over the next 10 years under the GOP plan. The falling coverage numbers and estimates of higher premiums for older and low-income Americans raised concerns among many lawmakers, particularly those representing states that expanded eligibility for Medicaid under the ACA.