House Republicans on Wednesday struggled to reach a consensus on the repeal of the Obama administration's landmark health-care law, with dozens of them expressing concerns that a proposed replacement plan would leave their constituents without coverage.
But a closer look at the list of holdouts shows they may be even more concerned about the political winds back in their home districts as they face contentious re-election races next year.
As of Wednesday afternoon, NBC News counted 19 House Republicans who were opposed to the bill, known as the American Health Care Act, which has failed to win enough support for GOP leadership to bring it to a vote. Another 24 were undecided, according to NBC News, and the count changed throughout the afternoon.
Republicans can only afford to lose 22 votes from their caucus, assuming no Democrats support the bill, to enact the controversial overhaul plan.
Two of the holdouts, Reps. Fred Upton, R-Mich., and Billy Long, R-Mo., said Wednesday they had decided to back the measure, helping to revive the legislation's chance of survival. But no vote has been scheduled and it's not clear if there was enough support to ensure passage.
An aide to Rep. Charlie Dent, R-Pa., told The Associated Press that Dent, a GOP moderate, remained opposed to the bill. He and other moderates have complained that the legislation erodes protections provided under the existing law that prevent insurers charging people with pre-existing illnesses unaffordable premiums.
That concern is widely shared by Democrats, many of whom represent districts that have seen substantial increases in health-care coverage. Nationally, some 20 million people have signed up for insurance since the law took effect in 2010.
Some GOP holdouts fear that provisions in their party's health plan could force some of those voters to drop coverage because they can no longer afford it.
The number of voters at risk varies widely from one congressional district to the next, according to estimates by the Center for American Progress, based on national Congressional Budget Office projections and local data on current health insurance enrollments.
But the risk of losing coverage appears to have little overall impact on GOP support for the new measure; House Republicans withholding support represent districts with a wide range of coverage at risk.