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As Democrats have delayed releasing their final health care reconciliation bill, they’ve consistently tried to create the impression that they’re essentially finished, but are merely waiting on the Congressional Budget Office. For instance, House whip Jim Clyburn told Fox earlier that, “We are still waiting on the CBO, the Congressional Budget Office, to give us its final number on what this thing will cost.” Yet the delay in releasing the bill and CBO score (which was initially supposed to come out as early as last week) has suggested something else – that early estimates from the CBO were bad, and they’re making changes to get the score that they want.

It now appears that this is precisely the case. A story from Congressional Quarterly reports:

House Democratic leaders are still struggling to produce a final health care overhaul bill at an acceptable official cost estimate, but Majority Leader Steny H. Hoyer said Tuesday they continue to plan a final vote this week. House leaders were to huddle late Tuesday afternoon, following a noon session of the full Democratic Caucus. There were reports they are having trouble drafting a bill that meets their budgetary targets….

Rank-and-file Democrats did not talk about the details, but said that the CBO scores had come up short.  “They were less than expected” in terms of deficit reduction, said Rep. Gene Green, D-Texas, who plans to vote for the bill.

There are several things that Democrats are up against when it comes to the CBO score. The most important is that, based on reconciliation instructions, the “fix” bill must be shown to reduce the deficit. The challenge is, that’s after assuming that the Senate bill is law. In other words, the reconciliation bill can’t claim any of the deficit reduction from the Senate bill, but rather it must reduce the deficit relative to the Senate bill. Yet the changes that are being talked about will cost a lot of money. This includes eliminating the “Cornhusker kickback” and offering enhanced Medicaid subsidies to all states, increasing subsidies for the purchase of insurance, eliminating the so-called "donut hole" on Medicare prescription drug benefits, and whatever else they put in the bill. At the same time, delaying until 2018 the enactment of the “Cadillac tax” would be scored as a reduction in revenue, and thus add further to the deficit. They’d have to make up the gap through tax increases as well as try to siphon “savings” away from the student loan bill. (More on that here.) But evidently it seems like they’re running into trouble on this front.

Another issue to keep in mind is President Obama’s pledge that the health care bill would cost “around $900 billion" The changes he’s proposed to the Senate bill would bring the total cost of health care legislation to $950 billion, according to the White House. Every dollar exceeding that will make it easier for Republicans to argue he broke his pledge, and at some threshold even the media will have to call him out on it. That isn’t a fight that Democrats are going to want to get into.

Also, Democrats need a CBO score that’s positive enough to help give Blue Dogs who claim to be fiscal conservatives an excuse to vote for the bill.

So this is why it’s Tuesday afternoon and we still haven’t seen a final bill or CBO score. They won’t release a bill as final if the score isn’t to their liking. Democrats could still keep making changes and coming up with new gimmicks to get the estimate that they want, but they do not have forever. If they want to pass a bill by Saturday night and post it online 72 hours in advance, then the latest we they could put things off would be until tomorrow.