It all came down to California.
Right up until the final hours before the vote, a number of California Republicans remained publicly undecided. Yet by the time the gavel came down, enough fell in line and voted with the majority of their party to nudge the bill over the finish line.
“This was a difficult decision,” Rep. Steve Knight (R-CA) told TPM moments after the vote, explaining that he didn’t make up his mind until late Wednesday night. “I talked to the Speaker, we went over about 10 different scenarios for [people with] pre-existing conditions, and nobody fell through the cracks,” he said. “Nobody anywhere.”
Many non-partisan health care groups have warned that the bill would allow insurers to significantly hike rates on people with pre-existing conditions and say millions of people will lose their health insurance entirely if the bill becomes law.
“It’s going to be controversial, but, you know, it’s about getting affordability back for middle-income folks and giving them choices,” Rep. Doug LaMalfa (R-CA), another last-minute yes vote, told TPM. “I’ve had middle-income people pleading with me to do something.”
LaMalfa said he had been on the fence due to concern that Congress had exempted itself from many of the bill’s most controversial provisions—shielding themselves and their staff from the waivers that could roll back protections across the country.
GOP leaders promised weeks ago that the provision would be stripped out, and followed through on that promise earlier on Thursday.
Both LaMalfa and Knight waved away the concern that nearly every single insurance plan in California would be ineligible for tax credits under the bill, because it bans any subsidy for plans that cover abortions, and California requires most plans to do so.
“California can adjust their abortion policy,” LaMalfa quipped. “I think the consensus in the country, whatever you think about abortion itself, is that federal funding of it is wrong. The state can adjust its policy towards that.”
Knight took a different view, expressing hope—as many moderates have—that the Senate will strip out some of the health care bill’s harshest provisions.
“This policy is far from being crafted,” he said. “This is going over to the Senate. There will be changes in the Senate. If they accept this and send it back 100 percent, I’d be shocked.”
Several other California Republicans—whose districts overwhelmingly voted for Hillary Clinton over Donald Trump—backed the legislation, included Reps. David Valadao, Dana Rohrabacher, Mimi Walters, and Ed Royce.
Another in this category, Rep. Jeff Denham (R-CA), told reporters he voted for the bill because he believes Obamacare has failed. “We have expanded coverage in our communities, but we have failed to expand access,” he said.
Rep. Darrell Issa (R-CA), who is particularly politically vulnerable, refused to comment on his yes vote.
— Nate Silver (@NateSilver538) May 4, 2017
Not one California Republican broke ranks. Not one California Democrat supported the bill.
The bill now moves to the Senate, which has shown little appetite for taking up the House’s health care bill.
Rep. Mark DeSaulnier (D-CA) told TPM Thursday that he is looking to his counterparts in the upper chamber to save the Affordable Care Act. “I have faith and hope in that institution that more rational minds will prevail,” he said. “Plus the [CBO] scoring will come out and people will realize it’s worse than the previous one.”
With mid-term elections approaching in 2018, and with a strong majority of people in California opposed to repealing Obamacare, the vote may turn out to be fatal for their careers.
Democratic lawmakers alluded to this when they broke out in song upon passage of the bill, wishing their vulnerable Republican colleagues a hearty “hey, hey, goodbye.”
“They voted for a bill that only 17 percent of the American public, including Republicans, support, and they’re going to pay a price,” DeSaulnier warned.