The Republican health care bill isn’t quite dead yet, but it’s not in excellent shape either. Even after changing the American Health Care Act to get the Freedom Caucus on board, Republicans still seem to be short of the necessary votes to pass the AHCA in the House. But getting the Freedom Caucus on board isn’t nothing — the bill is closer to passing than it was in March. The AHCA may still go down, but it would go down for a different reason than it did two months ago: The opposition is different than it was when it failed the first time.
On the initial version of the AHCA, “no” votes were coming from all ideological corners of the party; now, the revised AHCA has split the GOP along its left-right fault line.
According to a whip count from HuffPost’s Matt Fuller (plus new statements from House members), 26 House Republicans oppose the AHCA or are leaning1 that way. That’s three more than necessary to kill the bill.2 Of those 26 members, 24 have served in a previous Congress and therefore have an ideological score assigned on DW-Nominate’s first dimension. (DW-Nominate uses roll call votes to measure lawmakers’ ideology. Its first dimension goes from most liberal, -1,3 to most conservative, 1.)
Twenty-three of the representatives opposing the revised AHCA are more moderate than the average House Republican (that puts them on the left side of the chart above). That number is essentially unchanged from the 264 who opposed version No. 1 of the AHCA in March. Indeed, if a few more moderate GOP members who are still publicly undecided end up voting against the AHCA, then the revisions to the bill won’t really have picked up any votes from the moderate wing of the party.
Of course, the bill has become more conservative, so that’s not shocking. Last week’s MacArthur amendment was aimed at conservative critics of the original AHCA who were concerned that it left too much of the Affordable Care Act standing. On that score, the amendment seems to have been successful. In March, 23 likely AHCA opponents in the GOP were more conservative than the average House Republican. And 20 of those 23 also had negative scores on DW-Nominate’s second dimension, which in recent years has tended to capture how anti-establishment a member is. (Negative means more anti-establishment.) Now, there is only one Republican against the AHCA who is more conservative than the average House Republican.
So why did GOP leaders do things this way? There were enough moderate Republican “no” votes to kill the bill in March even if the Freedom Caucus had supported it. So the GOP leaders were always going to have to find a way to pick up moderate support. Indeed, GOP leaders are now adding funding to the bill in an attempt to quell moderates’ concerns that the AHCA doesn’t do enough for people with pre-existing health conditions.
Perhaps Speaker Paul Ryan went after conservatives first because he believed it would be easier to get the often uncompromising Freedom Caucus members, who usually vote together, in a bloc.
Or perhaps it’s simple politics. Even if the bill fails, Ryan still has the Freedom Caucus on board. And Ryan needs all the help he can get to maintain a cohesive Republican caucus; it was mostly Freedom Caucus members who forced out former House Speaker John Boehner. Moreover, Ryan may see benefit in passing a more conservative bill, even if it stands only a small chance of becoming law, to avoid being blamed for doing nothing to get rid of the Affordable Care Act. The original AHCA was deeply unpopular, even in many red House districts. Failing to pass a bill because it’s too conservative might play better politically for GOP House members than failing to pass a bill because it’s hated by everyone or seen as too moderate.
Either way, we’ll probably know by Thursday if Ryan and his leadership have been successful in drumming up the necessary votes in Round 2 of AHCA vote whipping. The House is set to go on recess at the end of the day Thursday.