House Republicans were between a rock and a hard place with the first version of the American Health Care Act, which repealed portions of Obamacare.
On the conservative end were Freedom Caucus Republicans, who felt the AHCA didn’t repeal enough of Obamacare, like the provision that doesn’t allow insurers to charge more based on preexisting conditions. On the other were moderate Republicans, who felt the bill took away health care from too many people.
If you charted House Republicans on a scale of conservative to moderate, you could see a U-shaped curve of opposition:
(We borrowed the scale from the Conservative Review, which scores each member’s voting record; since freshmen members didn’t have scores, they were excluded from this graphic.)
To get enough Republicans to pass the bill, House Speaker Paul Ryan had to win over one of these factions by either moving the bill to the left or the right.
His choice? He got rid of the rock on the right: mostly Freedom Caucus members.
As my colleague Sarah Kliff writes, the bill gave in to two big Freedom Caucus demands:
First, they wanted a bill that got rid of Obamacare’s requirement that sick and healthy people be charged the same premiums. Second, they wanted to end Obamacare’s essential health benefit mandate, which requires insurers to cover 10 types of medical care including hospital trips, maternity care, and mental health services.
Sure, some moderates who initially opposed the bill also supported this more conservative second version. But this bill was passed by winning over reluctant members on the right — one that was louder and larger than the dissent from more moderate lawmakers.
In short, the Freedom Caucus played a game of chicken with the rest of their House Republican colleagues, knowing that their votes were needed to pass any repeal bill — and they won.