On Thursday, as expected, the House of Representatives passed the American Health Care Act (AHCA), a bill that promises to cut government programs like Medicaid, weaken regulations on health insurance companies, and repeal taxes on the wealthy. The nonpartisan Congressional Budget Office (CBO) didn't have time to assess the bill's consequences on the federal deficit or how many people would be priced out of the insurance market, but a CBO score of an earlier version of the AHCA found that 24 million fewer people would have health insurance if the bill became law, and insurance would get much more expensive for old people and the sick.
The passage of the bill has no immediate effect. The Senate now needs to pass its own bill, which could substantially differ from the House AHCA, and the two chambers of Congress would then have to iron out the details before it goes to Donald Trump's desk for the president's signature. Mostly, today's vote lets Republicans in the House claim that they are doing something to repeal the Affordable Care Act (a.k.a. Obamacare). The specifics of the massively complicated piece of legislation, the result of three months of rushed compromise among House Republicans, were pretty much beside the point.
Even if the AHCA never becomes law, the politics of it may be hanging over some Republicans facing reelection in 2018. Twenty-three House Republicans are in districts won by Hillary Clinton last year according to Daily Kos, and many others have lots of constituents who disliked the bill. Voting for a bill that would result in millions losing their health insurance is so potentially fraught that Democrats (who all voted against the AHCA) taunted Republicans after the vote by singing, "Na-na-na, na-na-na, hey, hey, goodbye."
According to a New York Times vote-tracker, 20 Republicans voted no, while 217 voted yes. Among those who backed the bill were 16 from Clinton districts. Here's who they are, and whether they should be worried:
David Valadao – California: He represents the mostly Hispanic Central Valley, where his constituents benefited a lot from the ACA's Medicaid expansion. Just before the vote he was undecided—he had opposed the first draft of the AHCA, and his problems hadn't been addressed. So…. why'd he vote yes?
Ed Royce – California: Some of his Southern Californian constituents were protesting against the AHCA, but though he was undecided until it came time to vote he ended up following his party. He won 58 percent of the vote in 2016, so maybe he assumes he'll be safe.
Steve Knight – California: Another Southern Californian, Knight seems to have been persuaded that the new version of the bill did enough to pre-existing conditions. We'll see if he can persuade voters on that point—the weakened protections for pre-existing conditions was the most criticized part of the AHCA.
Mimi Walters – California: Her Orange County district is pretty conservative and she won nearly 60 percent of the vote in 2016. Still, her promise that the AHCA will lower premiums—a dubious statement—may make her more vulnerable. (She even supported the previous version of the bill.)
Jeff Denham – California: In case you haven't noticed, the California faction of the House GOP was key to this bill. Denham is one of the most vulnerable of the lot, having won last time by less than 5 percent; multiple Democrats are already declaring their intention to challenge him in 2018.
Dana Rohrabacher – California: His pro-Putin views make him an oddity already, but he's been in Congress since 1989 and won easily last time; he'll likely be fine unless 2018 turns into a massive wave election.
Carlos Curbelo – Florida: He was critical of the AHCA days ago, before an amendment offered an additional $8 billion to support high-risk pools for sick people who wouldn't be able to get insurance under the new system. But most experts say that that money won't be enough. It's going to be a tricky position to defend.
Erik Paulsen – Minnesota: In a statement after the vote, he denounced "skyrocketing costs, diminishing choices, and limited access," yet the AHCA will make health insurance more expensive for millions.
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Peter Roskam – Illinois: Weeks ago, Roskam said that the AHCA was open to change and appeared nervous about its impact on his district. Now he's defending it as a magic bullet that will drive down costs while protecting pre-existing conditions.
Pete Sessions – Texas: He won 70 percent of the vote in 2016, so he's likely safe.
John Culberson – Texas: He's stuck up for the AHCA in front of tough town hall crowds, so this is the hill he wants to die on. After getting 56 percent of the vote in 2016, he's far more vulnerable than Sessions.
Kevin Yoder – Kansas: "No one with pre-existing conditions can or will be denied affordable coverage under the AHCA now or ever," Yoder promised in a statement. That kind of blanket assurance sounds good until your opponent inevitably trots it out in an attack ad next to some study about how many people with pre-existing conditions would lose coverage.
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