Rep. Fred Upton (R-Mich.) speaks to reporters about health-care legislation after meeting with President Trump at the White House on May 3. (Jonathan Ernst/Reuters)

By their very nature, moderates rarely issue my-way-or-the-highway demands.

But Rep. Fred Upton (R-Mich.), the longest-serving member of the moderate Republican caucus, decided to play that role this week after watching the GOP leadership and President Trump’s top advisers cater the latest draft of their health-care bill to the needs of House conservatives.

“You’ve got a line in the sand, and, you know, this is a principle that I’ve stood on,” Upton told a local news radio station Tuesday. He declared the current version of the legislation dead on arrival because of moderate opposition.

“There are not the votes, as of this morning, to move this bill forward,” he told his hosts on “Real News Now” 1450 AM in Holland, Mich. Upton then issued the kind of ultimatum that has been more associated with the House Freedom Caucus, the bloc of roughly three dozen hard-line conservatives who forced the legislation to the right by refusing to budge.

“We’re not going to budge, either,” he said.

(Jenny Starrs/The Washington Post)

The reaction was swift: Upton soon was in House Speaker Paul D. Ryan’s office and by Wednesday morning found himself at the White House with Trump. A new amendment was in the works for an additional $8 billion to help provide premium support for those with preexisting conditions who live in states that opt out of the current coverage mandates.

It’s unclear whether Upton has provided enough policy protection for several dozen other wavering members of the Tuesday Group, as the moderate caucus is known. But once that deal came together, GOP leaders put together the final plans to hold a midday Thursday vote, betting that Upton’s support will bring along enough Tuesday Group members to pass the legislation and avoid another humiliating defeat.

Democrats immediately declared the funds insufficient to cover the expected higher premiums for those who get shifted into “risk pools” of people with preexisting illnesses, a collection of patients who would be the most expensive for insurers to cover.

The only immediate convert was Rep. Billy Long (R-Mo.), who serves on the Energy and Commerce Committee with Upton. Long seemed to coordinate his announcement of opposition to the bill with Upton earlier this week and then accompanied him to the Trump meeting.

[From 2011: For Upton, it’s game on]

Whatever else happens, Upton served notice that moderates might be a force to reckon with on other legislation.

After six years of watching the Freedom Caucus dictate policy outcomes, even helping force John A. Boehner (R-Ohio) out of the speaker’s office, moderates finally demanded something. They would not go along with legislation that, in its latest form, would expose them to political attacks in next year’s midterm elections for going back on their promises about how they would replace the Affordable Care Act.

(Reuters)

Upton also stood up for the committee process and “regular order.” Before he hit his six-year term limit last year, Upton was chairman of the Energy and Commerce Committee, which has more jurisdiction over the U.S. economy than any other congressional panel.

The committee spent weeks this year drafting the initial legislation, which faced plenty of Democratic criticism after an independent report estimated that it would leave 24 million additional Americans without health insurance over the next decade.

But the committee’s initial bill left in place the “Essential Health Benefits” section of the 2010 health law, which included a very popular mandate that forbids insurers from denying coverage to new customers because they had preexisting conditions. Almost every Republican, including Trump while campaigning for president and Ryan (R-Wis.) as his party’s 2012 vice-presidential nominee, vowed to maintain that safeguard.

“It’s been in all my [constituent] letters, all my responses, thousands of folks that have contacted me over the last year or so,” Upton told his local radio hosts. “The way that it is now, I can’t support it.”

To be clear, Upton was not just speaking for himself. Behind him were a dozen, perhaps several dozen, rank-and-file Republicans who do not have the clout that he has earned over more than three decades in Congress.

“There are a good number of us that have raised real red flags and concerns,” Upton said Tuesday.

He was a team player for Boehner and then Ryan as committee chairman, but he has bipartisan credentials. The 21st Century Cures Act, a massive infusion of money to fight cancer and other diseases, came out of Upton’s committee and received nearly 400 votes on final passage in November.

[Congress set to vote on bill that promises to speed up drug approval]

A political survivor, Upton can speak up to leadership in ways that other moderate newcomers cannot. His western Michigan district voted for Barack Obama in 2008 but Republican Mitt Romney narrowly won it in 2012, before Trump ran up a victory last year of more than eight percentage points.

Despite that swing nature, Upton easily survived in 2006 and 2008, terrible years for Republicans, and in the tea party era, he stared down a well-funded challenge from his right in the 2012 Republican primary, winning by 2 to 1.

But Upton wants to get to yes. He hates Obamacare.

After the 2010 elections thrust Republicans into the majority, Upton overcame concerns with his moderate nature to win the coveted Energy and Commerce Committee gavel.

His presentation to leadership consisted of him pulling out the game Jenga, stacking up the series of blocks into a high pile, as the bemused lawmakers wondered what he was doing.

One by one, he pulled out a block explaining which piece of the ACA he wanted to repeal.

“It’s like this game,” he told The Washington Post in an interview a few weeks later. “We’re going to pull out the pieces.”

Eventually the entire Jenga set crumbled.

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