The American Health Care Act isn’t dead yet. An amendment offered by New Jersey Rep. Tom MacArthur pushed the bill to the right, and as a result the Freedom Caucus — which opposed the AHCA originally — has now endorsed the bill. The endorsement suggests that most of the 30 or so Freedom Caucus members1 will vote “yes” if the bill is brought to the floor.
But it’s not clear how much the Freedom Caucus reversal increases the AHCA’s prospects of being signed into law. Republicans still face a major problem among more moderate Republicans in the House. And the MacArthur amendment likely makes passage in the U.S. Senate even more remote.
The AHCA didn’t fail in March solely because of Freedom Caucus opposition. As I noted at the time, the most conservative members of the Republican House caucus were no more likely to oppose the bill than your average GOP representative. Instead, two groups of Republicans were most likely to oppose the AHCA: moderate GOP representatives and anti-establishment GOP representatives.
You can see both blocs on the chart below, which shows the two dimensions of DW-Nominate scores, which measures each member’s ideology based on roll call votes from previous congresses. GOP House members on the left of the chart are more moderate (as seen through lower DW-Nominate first dimension scores), while those on the bottom half are more anti-establishment (as seen through negative DW-Nominate second dimension scores). Among the 49 House Republicans who were identified as leaning “no” on the AHCA earlier this month,2 a little more than half were more moderate than the average House Republican.
Because Trump and House Speaker Paul Ryan can afford only 22 Republican defections for the bill to pass, every single conservative House member previously opposed to the bill could vote “yes” and it would still not be on track to make it out of the House. Instead, the AHCA would probably need somewhere in the neighborhood of five to 15 moderate Republicans who opposed the AHCA the first time around to jump on board (depending how many previously opposed conservative members do).
That could happen, but as moderate GOP Rep. Charlie Dent has pointed out, the new amendment could also lead to additional centrist Republicans coming out against the bill. There’s a group of House Republicans, about 303, who never signaled either way where they stood on the AHCA when it first came up. Perhaps they were hoping that they wouldn’t have to take a public stand — support a very unpopular or break with their party. Now, they may have to show their cards. And of the 30 members of this group for whom we have an ideological score, 16 were more moderate than the average House Republican. Even if AHCA backers are able to get most of this group, every defection makes it that much less likely the bill will pass the House.
But let’s say Trump, Ryan and the GOP leadership get the legislation out of the House. They still have a major problem in the Senate. If every Senate Democrat opposes the AHCA, the White House can afford only two Republicans voting against the bill.4 New York magazine counted at least 10 Senate Republicans in late March with major concerns about the AHCA. The revisions to the bill seem designed to make it less likely to pass in the Senate.
Senate Republicans are more moderate than their House counterparts. Of the 49 Senate Republicans for whom we have an ideological score, 29 were more moderate than the average House Republican. As of late March, at least six of these 29 (Shelley Moore Capito, Bill Cassidy, Susan Collins, Dean Heller, Lisa Murkowski and Rob Portman) had major reservations with the AHCA. And all of these reservations had to do with constituents’ losing coverage. Considering that the new AHCA amendments loosen requirements for coverage even further, it doesn’t seem likely that many of these six will hop aboard.
Perhaps the biggest problem with the new AHCA amendments: They do nothing to solve the bill’s biggest political problem, massive unpopularity. A lot of opposition to the original AHCA came because it was unpopular with constituents. That’s a big reason Arkansas Republican Sen. Tom Cotton opposed it, for example. Given that most of the resistance to the AHCA came from Democrats and independents, it doesn’t make sense that the AHCA would become any more popular now that it’s moved further right. If Republicans are going to pass the AHCA, they’ll probably have to do it with the majority of Americans opposed to it.