Hard-line conservatives have threatened to upend the GOP’s drive to replace Obamacare, but the real peril may come from a quieter group of moderates.

The two dozen House Republicans who outran President Donald Trump at home — in some cases surviving even as Hillary Clinton won their districts — are now facing a vote on health care that could put their political careers on the line. Though Obamacare has never been widely popular, the law has gained support in recent weeks as Republicans inch closer to repealing it. And the GOP plan to replace it is drawing fire from important constituencies, from hospitals to AARP.


Republican members in swing districts are likeliest to feel the squeeze — and would be taking the greatest political risk to back the president and the party.

“This is a difficult vote … There’s always been concern from our members,” said Rep. Charlie Dent (R-Pa.), who leads the Tuesday Group, the House GOP’s caucus of moderates. “I watched the Obamacare debate back in 2010, and I saw that their more centrist members were put in a difficult predicament. I suspect the flip happens this time.”

Centrists present a unique challenge for GOP leadership, whose whip team started courting the center-right weeks before the rollout of their health care plan. While most moderates enjoy good working relationships with leadership — many sit on the committees that are crafting the Obamacare overhaul — they may be the least susceptible to pressure from Trump, given his low ratings in many of their districts.

“A tweet from the president for these guys doesn’t have the same impact as it would on [House conservatives] Mark Meadows or Jim Jordan,” said one senior GOP source.





Democrats, meanwhile, are practically daring the swing-district Republicans to vote yes, vowing to make health care the driving issue in next year’s midterms. They’re keeping a list of targets and preparing to run ads against centrists who support the bill.

“When vulnerable Republicans inevitably toe the party line and vote to rip health care away from their constituents, you can be sure that they will be held accountable at the ballot box,” Tyler Law, a spokesman for the Democratic Congressional Campaign Committee, said in a statement.

Well aware of the potential blowback, many centrists are refusing to say how they’ll vote.

“I’m still evaluating,” said Dent. “I haven’t made a final determination.”

Another moderate, New York Rep. John Faso, recently blasted his party’s plan to use the health care legislation to strip funding from Planned Parenthood, calling it a “gigantic political trap” that “arm[s] our enemies.” But Faso also declined to divulge his position on the GOP plan unveiled Tuesday.

As the debate heats up ahead of an expected late-March floor vote, Republicans from competitive districts, such as Virginia’s Barbara Comstock, are playing up parts of the replacement bill that most resemble Obamacare. Comstock is considered one of the most vulnerable GOP House incumbents.

Some centrists, however, are going all in in support of the Republican health care alternative, calling it a big improvement over Obamacare.

“I’m confident it will pass,” said New York Rep. Chris Collins, a top ally of Trump on Capitol Hill. “Everyone understands the posturing before a vote. But how could any Republican go home and say they voted against repeal and replace?”

Rep. Steve Stivers, who runs the House GOP campaign committee, said he hasn’t detected deep worry among moderates about the political ramifications of the health care bill.





“I think we’ve got great members who know their districts and know what they need to do,” the Ohio Republican said. “I think these members will be able to decide for themselves what makes sense for them.”

Stivers’ predecessor at the National Republican Congressional Committee, Greg Walden — who’s now the House Republican point man on health care — said nearly every GOP House member campaigned on repealing and replacing Obamacare, even those in swing districts. He emphasized that the core aspects of Obamacare that moderates are particularly concerned about — ensuring coverage options for people with preexisting conditions, eliminating lifetime caps on coverage and allowing young adults to remain on their parents’ health plans — would be largely preserved.

“I think this is a thoughtful policy that every member can go back and be proud to have supported, depending upon your district,” he said.

Some moderates are also hopeful they can secure changes to the bill that will make it more palatable. At a meeting with Health and Human Services Secretary Tom Price on Tuesday, Dent and other Tuesday Group leaders questioned whether the GOP tax credits would be sufficient to help Americans buy insurance. Others, including Rep. Dan Donovan, another New Yorker, say they’ve raised “concerns” about the GOP proposal’s phase-out of Obamacare’s expansion of Medicaid, which has helped millions of low-income people gain coverage.

The latter is a particularly thorny issue for moderates because many hail from states that took the Medicaid expansion and fear their vote will effectively end care for some low-income people. Centrists are also under pressure from their home-state governors to protect the coverage gains at home. Donovan said he and New York’s other Republican lawmakers recently met with Walden to discuss their issues with the legislation.

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“Let’s help the people who are harmed by the Affordable Care Act but at the same time not harm the people who are helped by it,” said Donovan, whose Staten Island district is packed with blue-collar workers. He spoke favorably about the GOP bill but said he expects that the version of the proposal currently circulating among lawmakers “will not be the final version.”

Moderates are also sensitive to the number of middle-income people who will lose insurance under the plan — and they’re not happy that GOP leadership has moved the replacement bill without a score from the Congressional Budget Office estimating how many will lose coverage. They’re also trying to get GOP leadership to drop a provision in the bill to defund Planned Parenthood. The Senate, they argue, is certain to strike the language anyway.

Moderates, more than any other members of the House GOP conference, will pay the price if the politics of health care reform efforts shifts in Democrats’ favor.

“I think anytime you’re dealing with something that touches upon the human being’s family and their health needs,” said Rep. Ryan Costello of Pennsylvania, it “can create political vulnerabilities.”