Three groups of Republicans to watch on the House health care bill

The American Health Care Act is only a day old, and it's already been met with a chorus of condemnations. It's certainly not dead yet, but it's not exactly thriving. Any one of three groups could scuttle it.

1. The far right of the Republican Party. Within the GOP, staunch conservative politicians and groups have objected most vocally to the bill so far, because they're upset that it doesn't do enough to roll back Obamacare. Heritage Action, the Club for Growth, Freedomworks, Americans for Prosperity, and Freedom Partners have already declared their opposition to the current draft. Sens. Rand Paul (R-KY) and Mike Lee (R-UT), and several members of the House Freedom Caucus, have joined them.

2. Mainstream members who listen to lobbyists. Many of the more moderate Republicans in the House and Senate are receptive to lobbying from important interest groups. So if associations representing doctors, hospitals, or insurers say the bill has problems, the House could well slam the brakes. (And lo and behold, on Tuesday afternoon, the American Hospital Association wrote that it "cannot support the American Health Care Act in its current form.")

3. Vulnerable members. Swing district representatives are already blanching at the prospect of a tough reelection fight. These are the members who really have their careers on the line, and several of them expressed misgivings about repeal and replace in leaked audio from a congressional retreat in January.

Overall, despite the early criticism, the vast majority of Republicans in Congress haven't weighed in just yet. That makes sense — those members want a chance to digest what's actually in the bill, to take the temperature of major interest groups, and to hear from their constituents.

The problem is that the extremely aggressive legislative calendar won't give them much more time to make up their minds.

What comes next

1. Markups begin tomorrow: The House Energy and Commerce Committee and Ways and Means Committee will begin marking up their respective portions of the AHCA at 10:30 am Eastern. The markups are expected to be quick — a few days at most, not weeks — before a final vote in each committee.

Four defections in either committee would prevent the bill from winning majority support. So if you're watching, keep an eye on the members in districts Hillary Clinton won last fall.

For Energy and Commerce, that's Reps. Mimi Walters (CA), Leonard Lance (NJ), and Ryan Costello (PA). For Ways and Means, it's Reps. Carlos Curbelo (FL), Erik Paulsen (MN), Peter Roskam (IL), Dave Reichert (WA), and Pat Meehan (PA).

2. The CBO score will come before the full House votes: Energy and Commerce Chair Greg Walden confirmed at a Tuesday morning press conference that "there will be a CBO score coming, and we look forward to that before [AHCA] comes to the House floor."

Walden didn't promise the score would come before his committee votes. That seems to put the members of the two committees in a tough spot, as they'll be forced to vote on the bill without knowing its estimated costs or how many people would lose coverage — something that could come back to haunt them in attack ads.

3. For the full House, 22 Republican defections would likely kill the bill: That's if Democrats remain united in opposition, as expected. The math is that there are 430 sitting members of Congress, so 216 yea votes are needed for a majority if everyone votes yea or nay.

237 members are Republicans, so they can afford to lose 21 of their own members' votes, but no more. Keeping in mind that there are 23 House Republicans in districts Clinton won, and at least 29 in the Freedom Caucus who could oppose the bill from the right, it's not all that hard to count to that number.

4. If something does pass the House, Senate leaders might bring it to the floor right away: I've been hearing rumors for a while that Senate Majority Leader Mitch McConnell might bypass his chamber's venerable committee process. Those rumors got some corroboration today from his deputy, John Cornyn, who told reporters that he expects a House-passed bill would be brought straight to the Senate floor.

Considering the timeline McConnell is laying out — he claims he wants a bill passed before the Senate's mid-April recess — he'd essentially have to skip the committee process. But senators used to weighing in extensively on proposed legislation likely won't be too thrilled about that.

This is a really aggressive timeline

I've said it before, but this is a remarkably rapid timetable for legislatively restructuring such an immense portion of the US economy.

The reason big legislation usually takes a long time is that the process involves getting major stakeholders on board. It involves rebutting criticisms, adapting to potential concerns, and building a strong case for why the bill is indeed a good idea.

Puzzlingly, McConnell and House Speaker Paul Ryan don't even seem to be trying to conduct this traditional process. Instead, they've adopted a "damn the torpedoes, full speed ahead" approach, simply daring their members to vote no.

Maybe they know where their members are and they're rightly confident that they can in fact muscle this through.

Maybe they're not at all confident they can get it through, but they've concluded that their only real chance of success, however small, is to move quickly.

And maybe they've also calculated that if their repeal bill blows up quickly, Republicans will be able to move on to other things on their agenda without having wasted months and months on a doomed health care plan.

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