As the House GOP prepares for a vote tomorrow on the American Health Care Act (ACHA), it appears unlikely that they will have the votes needed to shepherd the bill over to the Senate. The primary obstacle at the last minute has been the bill’s biggest obstacle all along: the House Freedom Caucus (HFC), a group of hardline conservatives in the House.


Nearly all of the HFC’s members have spoken out against the AHCA since it was released two weeks ago, and the tumultuous process of attempting to secure Republican votes for the measure has focused primarily on winning over these members.

Over the past two weeks, President Donald Trump, Vice President Mike Pence, and Speaker Paul Ryan have conducted several meetings with members of the Freedom Caucus in order to reach a compromise. The House GOP even made a few changes to the bill in an effort to resolve some of the outstanding issues that opponents raised after the rollout.

None of those changes has been enough to appease conservative members, many of whom insist that the GOP must “start over” with a whole new bill. Freedom Caucus chairman Mark Meadows (R., N.C.) insisted this afternoon that the bill still doesn’t have the votes to pass tomorrow.


“Many of you came in on the pledge to repeal and replace Obamacare,” Trump said in a recent closed-door meeting with conservative members. “I honestly think many of you will lose your seats in 2018 if you don’t get this done.”


But HFC members maintain that their constituents expect them to repeal Obamacare in full, not pass a half-hearted measure like the AHCA that leaves many of Obamacare’s key structures in place.

As of this afternoon, it seems Meadows is correct that there remain enough opponents to tank the bill tomorrow; the GOP can only afford to lose 21 of its own members’ votes, along with all of the Democrats. According to a New York Times count, 22 GOP representatives are hard “no” votes, with another 17 who have serious reservations about the bill. And a recently updated Huffington Post piece suggests that there are at least 29 GOP representatives who are extremely likely to vote against the bill, while another 12 lean “no.”

Despite the clear danger to the bill, House leadership has made no moves to reschedule Thursday’s vote and has yet to acknowledge the possibility that the AHCA might be defeated tomorrow.



Meanwhile, a number of prominent conservative think tanks and lobbying groups remain firmly opposed to the AHCA, including Heritage Action, Club for Growth, and Americans for Prosperity. Like the HFC, these groups note that GOP leaders have promised for years to repeal Obamacare, and the AHCA is a failure because it leaves much of Obamacare intact.

Even if the bill were somehow to pass the House in its current form, it will face significant challenges in the Senate, where both conservative and moderate Republicans have expressed reservations about it. Senators Rand Paul (R., Ky.) and Mike Lee (R., Utah) have indicated that they will vote “no” on anything other than a full repeal of Obamacare.

Ted Cruz of Texas announced recently that he cannot vote for any repeal-and-replace bill that doesn’t address the issue of rising premiums; the AHCA is estimated to raise premiums for the next few years before lowering them by 2026. Wisconsin senator Ron Johnson has noted that to say he is “skeptical” of the AHCA would be an “understatement.”

Moderate GOP senator Susan Collins of Maine came out last week as a firm “no” vote. In January, Collins and Bill Cassidy (R., La.) introduced a health-care reform bill that would give states the choice of whether or not they want to remain within the Obamacare system.