Paul Ryan has a major math problem.

The House speaker and his leadership team can lose only 22 Republicans and still pass their Obamacare repeal bill. But roughly 20 GOP members are on record in opposition, and at least another two dozen are undecided.


The situation has gotten only uglier this week, as two leadership-aligned congressmen, Fred Upton (R-Mich.) and Billy Long (R-Mo.), came out against the plan.

Leaders have won over all but a few members of the House Freedom Caucus and at least one big-name moderate who opposed the earlier Republican proposal. But the path to 216 votes is exceedingly thin.

Here are some of the key members to watch in the coming days to gauge whether the House can pass the bill.

The trendsetters

Want to know whether this bill will pass the House? Watch Upton.

There are run-of-the-mill “no” votes on the GOP’s health care plan, and then there are red-alert defections that underscore the crumbling position that House leaders are in as they seek support for the legislation. Upton is one of those.

The former Energy and Commerce Committee chairman knows health policy and previously crafted several Obamacare repeal proposals. He’s also typically allied with leadership, so his opposition to the American Health Care Act gives skittish Republicans cover to break with leadership.

One party leader said Upton’s announcement could clinch a decision to put off a vote on the health care measure this week — and possibly forever. And a member of the House’s whip team, who currently backs the bill, told POLITICO Tuesday that he was rethinking his support as a result of Upton’s opposition.

Long’s recently declared “no” vote was also huge. He represents one of the most conservative districts in the country and had been a steadfast ally of President Donald Trump.

“Billy Long is a mega Trump cheerleader. For him to come out as no? I was shocked,” said Rep. Tom Rooney (R-Fla.).

The undecideds

More than two dozen lawmakers, most hailing from swing districts that Hillary Clinton carried on Election Day, say they have not made up their minds on how they will vote.

Some of them backed earlier versions of the bill but are getting cold feet on a revision crafted by moderate Rep. Tom MacArthur (R-N.J.) and conservative Rep. Mark Meadows (R-N.C.).

Take Rep. Mike Coffman (R-Colo.). Just four weeks ago, he said he had no choice but to vote for the GOP health care plan after running on repealing Obamacare. But constituents pummeled him at a town hall in mid-April, and Coffman swore he'd never back a bill that would hurt people with pre-existing conditions. Coffman now isn't saying where he stands on the GOP's latest plan.

Rep. Darrell Issa, who won reelection last year by fewer than 1,000 votes, also remains undecided on the vote. | Getty

He has plenty of company. Rep. Elise Stefanik (R-N.Y.) has dodged questions by telling reporters to “reach out to my office” and walked out of meetings with her cellphone plastered to her ear.

Also undecided and worth keeping an eye on is Rep. Darrell Issa (R-Calif.). He won reelection last year by fewer than 1,000 votes. The make-up of his Southern California district is shifting so rapidly to the left that the multi-millionaire businessman, who enjoys a friendship with Trump, has had to rethink all his positions.

The quiet leadership supporters

GOP leaders are banking on almost all of the undecided lawmakers to “row with the team,” as they like to say. And the reality is that a large chunk of those members will probably vote for the bill — as long as the vote is close.

Rep. Erik Paulsen, for example, rooms with Majority Whip Steve Scalise (R-La.) and serves on the whip team. The Minnesota lawmaker, who backed the previous bill, now says he doesn’t know how he will vote. But insiders expect him to be there for leadership if needed.

Rep. Mike Turner is another. The Ohio Republican has said he's undecided, avoiding question from reporters. But the eight-term lawmaker wants a chairmanship, and there’s no way he would get one if he defied leadership at such a critical moment.

Rep. Carlos Curbelo may also fall into this category. While Curbelo hails from a swing district outside Miami, he enjoys a strong working relationship with leadership. Curbelo backed part of the bill in the Ways and Means Committee and now says he will decide how to vote once leaders schedule a roll call.

Most of the members in this camp just don’t want to say publicly they will likely vote for the bill. And in refusing to take a position, they buy themselves cover to flip to “no” if the vote goes south.

The “hell no” moderates

A handful of moderate Republicans blasted the bill early on and made clear there was virtually nothing House leaders could do to lure them back into the fold.

They include centrist Rep. Charlie Dent (R-Pa.), who said early on that the House GOP Obamacare alternative failed to protect people in his district and harmed Medicaid recipients. Trump tried once to change Dent’s mind during a White House meeting. And when the outspoken Tuesday Group co-chairman wouldn’t budge, the president accused him personally of ruining the Republican Party.

Rep. Leonard Lance (R-N.J.) has been adamant that he's a "no." And Rep. Ileana Ros-Lehtinen, whose Florida district is home to the largest number of Obamacare beneficiaries, made clear she was off the Trumpcare train and never reboarding.

These members represent the most centrist elements of the House GOP caucus. They and their allies come from classic swing districts, where Obamacare is more popular and constituents are less interested in supporting Trump’s agenda.

Allies of House leadership often predicted that moderate members would ultimately fold and back the bill — they’re much better team players than the hard-line conservative House Freedom Caucus, the thinking went.

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But last-minute moves to appease Freedom Caucus members irked many of these members, and the steadfast opposition from Dent, Lance and others has helped embolden them to resist pressure to cave to the White House.

The conservative holdouts

While most House Freedom Caucus members have endorsed the health care legislation, at least three hard-line conservatives are resisting.

Freshman Rep. Andy Biggs, who recently replaced exiting Freedom Caucus founding member Matt Salmon, is the lone caucus member to say he will vote against the legislation. The Arizona Republican argues that even the amendment co-authored by Meadows, chairman of the Freedom Caucus, would keep the “framework of Obamacare in place, while taking credit for its full repeal.”



Biggs isn’t alone. Two non-Freedom Caucus conservatives have also come out against the revised draft of the health care bill. Rep. Walter Jones (R-N.C.) says he’ll oppose the measure because it hasn’t been scored by the Congressional Budget Office. And libertarian-minded Rep. Thomas Massie (R-Ky.) won’t back the bill because, well, he rarely votes for anything.