It all came down to the moderates.
The Affordable Health Care Act squeaked through the House, 217-213, after a rush of last-minute reversals Thursday from GOP lawmakers who had been undecided or telegraphed staunch “no” votes.
Citing the need to take some action towards repeal, discussions with President Donald Trump and a Hail Mary pass of an amendment to fund coverage for patients with pre-existing conditions, Republicans from purple districts, like Rep. John Faso (R-NY) and Rep. Brian Mast (R-FL), and even Rep. Carlos Curbelo (R-FL), whose district went for for Hillary Clinton in November, ended up supporting the bill.
Rep. Fred Upton (R-MI) can take much of the credit, as he drafted the amendment that would give $8 billion over five years to cover people with pre-existing conditions that provided other moderates with political cover. Co-sponsors Reps. Jeff Denham (R-CA) and Don Young (R-AK), as well as Carlos Curbelo (R-FL) and Billy Long (R-MO), cited those additional funds as essential to swaying their votes
These are the House lawmakers whose votes ensured the passing of the AHCA:
Fred Upton (R-MI)
Represented Sixth District since 1987
Member’s share of vote in 2016 congressional election: 58.6 percent
How the district voted in 2016 presidential election: Trump 51 percent
Upton formally came out against the bill Tuesday to GOP leadership and in an interview on local Michigan radio. But within 24 hours, after a phone call from Trump and a meeting at the White House, the influential former chair of the House Energy and Commerce Committee reversed course.
He unveiled an amendment that provides $8 billion over five years to finance high-risk pools and bolster coverage for patients with pre-existing conditions in states that seek waivers to certain Obamacare mandates, as the AHCA allows them to do in its current form.
Though he admitted he didn’t “know” if this funding would be sufficient, Upton said the Senate and Congressional Budget Office score would help sort that out down the line.
Billy Long (R-MO)
Represented Seventh District since 2010
Member’s share of vote in 2016 congressional election: 67.5 percent
How the district voted in 2016 presidential election: Trump 70 percent
A close Trump ally, Long surprised members of his caucus on Monday by announcing he could not support the revised version of the AHCA because he said it “strips away any guarantee that pre-existing conditions would be covered and affordable.”
As with Upton, face time with the President helped sway Long’s vote. He also expressed confidence that the additional funds in Upton’s amendment would protect those with pre-existing conditions, like his daughter, a cancer survivor.
“They need to be covered, period,” Long said Wednesday.
Marc Amodei (R-NV)
Represented Second District since 2011
Member’s share of vote in 2016 congressional election: 58.3 percent
How the district voted in 2016 presidential election: Trump 52 percent
The Nevada Republican was listed as a “no” on some publications’ whip counts until as late as Thursday morning. Amodei consistently expressed concern that the AHCA as drafted would lead to a massive budget shortfall for Medicaid in the Silver State.
By late Thursday morning, Amodei released a statement explaining that he flipped to a “yes” as a result of “extensive discussions” with Health and Human Services Secretary Tom Price and Vice President Mike Pence, as well as “extensive research” conducted by his office.
“I have concluded that the potential for Nevada deficits or expanded Medicaid enrollees being kicked off of Medicaid will be avoided,” Amodei said in the statement. He predicted that the “raucous discussion” over the details would continue in the Senate.
John Faso (R-NY)
Represented Nineteenth District since 2017
Member’s share of vote in 2016 congressional election: 54.1 percent
How the district voted in 2016 presidential election: Trump 53 percent
A member of the moderate Tuesday Group, Faso has played a key role in dictating the overhaul of the Affordable Care Act. He expressed support for the initial draft of the legislation, which was yanked from the floor before it could come to a vote in March, and pushed heavily to shift the cost of Medicaid from individual counties to the state.
“My view has never been to repeal and replace. My view has been to keep what works and fix what doesn’t,” Faso said in April.
On Thursday, Faso released a short statement on Twitter saying that amendments to the bill proposed over the past week “addressed his concerns” and that he planned to support the legislation.
Elise Stefanik (R-NY)
Represented Twenty-First District since 2015
Member’s share of vote in 2016 congressional election: 66.1 percent
How the district voted in 2016 presidential election: Trump 54 percent
At the start of the Trump administration, Stefanik said that Obamacare repeal should be rolled out slowly, in a multi-year process that maintained some parts of the original law.
“My priority is ensuring that we not pull the rug out from under individuals who are on Obamacare,” Stefanik said in January. “So right now there’s a lot of discussion about what the time horizon is. I want a multi-year process before repeal is actually implemented.”
She was undecided on the initial bill in March, even after working with three other representatives to secure an additional $15 billion for substance abuse treatment, mental health care and maternity care.
Stefanik remained undecided on the newest iteration of the bill until hours before Thursday’s vote, when she announced: “The American Health Care Act is not perfect, but it is an important step in reforming our broken healthcare system to help families in our district.”
Brian Mast (R-FL)
Represented Eighteenth District since 2017
Member’s share of vote in 2016 congressional election: 53.6 percent
How the district voted in 2016 presidential election: Trump 53.3 percent
Freshman lawmaker Mast appeared to lean in the AHCA’s favor before it was pulled from the floor in March, emotionally calling for his colleagues to sign onto the bill and likening GOP unity on voting for it to the unity that he and his fellow soldiers used to win battles while stationed in Afghanistan.
Mast was still “looking at” the bill’s language on Wednesday, but officially came out as a “yes” on Thursday morning.
“Inaction is the worst thing we can do. There are people out there at risk of not having any coverage,” Mast told Politico. “If there are no providers out there, then people with pre-existing conditions absolutely aren’t covered. So this is the right thing to do.”
Doug LaMalfa (R-CA)
Represented First District since 2013
Member’s share of vote in 2016 congressional election: 59.1 percent
How the district voted in 2016 presidential election: Trump 56.2 percent
LaMalfa had been undecided but leaning yes on the bill, so long as he felt confident that original Medicaid recipients would retain coverage. Moments before stepping into the chamber to vote Thursday, LaMalfa told TPM he would vote “yes.”
“To do nothing would be wrong because people that are subject to these higher costs have been pleading with us for several years to rectify their ability to have choices, to have insurance they can afford,” he said.
LaMalfa said confirmation that Congress and their staffers would not be exempt from changes to the bill helped change his mind, as did his feeling that there is a growing “consensus” that no federal money should go towards abortion.
California requires all insurance plans to cover abortion and the GOP’s bill prohibits its new tax credits from going to plans that do, meaning all Golden State plans could essentially be ineligible.
LaMalfa said that “California can adjust their abortion policy” to address this.
Jeff Denham (R-CA)
Represented Tenth District since 2013
Member’s share of vote in 2016 congressional election: 51.7 percent
How the district voted in 2016 presidential election: Clinton 49 percent
While he did not explain his reasoning, Denham said throughout the week that he planned to oppose the revamped AHCA. But he then co-sponsored the Upton amendment and ultimately voted yes.
His district narrowly supported Hillary Clinton in the 2016 election.
Carlos Curbelo (R-FL)
Represented Twenty-Sixth District since 2015
Member’s share of vote in 2016 congressional election: 53 percent
How the district voted in 2016 presidential election: Clinton 56.8 percent
Curbelo said as recently as Wednesday that the current version of the AHCA “fails to sufficiently protect Americans with pre-existing conditions.” But he was apparently swayed by the Upton amendment, which he said he discussed with the lawmaker, and voted to support the bill.
The congressman’s office said it was a “game-time decision,” though he reportedly had statements supporting it set to be sent out moments after it passed.
Curbelo’s district voted for Clinton by a 16-point margin in November.
Don Young (R-AK)
Represented at-large district since 1973
Member’s share of vote in 2016 congressional election: 50.3 percent
How the district voted in 2016 presidential election: Trump 51.3 percent
Young was consistently undecided on the bill, and opposed its first iteration in March. He said at the time that he wanted to wait until 2020 to repeal the Affordable Care Act after working with Democrats on a bipartisan replacement bill.
Yet on Thursday, he voted for it. A Vox reporter says Young cast his vote right after he was approached by Rep. Patrick McHenry (R-NC).
Justin Amash (R-MI)
Represented Third District since 2011
Member’s share of vote in 2016 congressional election: 59.5 percent
How the district voted in 2016 presidential election: 52 percent
The strict libertarian and Freedom Caucus member was one of the staunchest opponents of the initial version of the AHCA, criticizing leadership for misrepresenting the legislation and boasting on Twitter and to the press that he had no intention of voting for it.
The Freedom Caucus provision allowing states to waive Obamacare mandates apparently helped sway his vote, tough, as he cast a “yes” vote on Thursday.
“I think it’s not great policy, just like ObamaCare is not great policy,” Amash told The Hill shortly before. “[But] it’s likely a marginal improvement over ObamaCare. I’m an incrementalist, and we’re working through the details.”