None of this is inevitable. The Republican health care plan might not even pass the Senate, and it could change significantly if it does. Perhaps it will become more popular over time, especially if Republicans become more unified behind it.
But the Affordable Care Act did a lot of damage to the House Democrats who voted it into law.
A study by the political scientists Brendan Nyhan, Eric McGhee, John Sides, Seth Masket and Steven Greene showed that the Democrats who voted against the A.C.A. outperformed those who voted for it by a net 10 to 15 points in 2010. (Mr. Nyhan is an Upshot contributor.) Our estimates are lower, at around 5 to 10 points, in part because many of the Democratic A.C.A. opponents fared particularly well in the 2008 elections, but it’s a considerable effect either way. (Our estimates are based on the results of recent congressional and presidential elections by district, member ideology and whether the candidates voted for the A.C.A.)
This doesn’t necessarily mean that the Democrats would have done 5 to 10 points better in the 2010 midterm elections if they had never pursued the Affordable Care Act. It just means that the members who didn’t vote for it did better than those who did. It’s a subtle distinction, but there is a difference: In a tough national environment in 2010, Democrats who voted against the A.C.A. found it easier to distinguish themselves from the national party.
The House Democrats who did vote for the A.C.A. were punished for it in a particular way, too. They struggled to do much better than recent Democratic presidential candidate, whatever their performance in recent elections. The Democrats who voted against the A.C.A., on the other hand, outperformed.
These results tell a pretty clear story about who could be hurt the most this midterm: the Republicans who ran well ahead of the national party in 2016 but who voted for the A.C.H.A. and were subsequently seen as no different from Donald J. Trump. On the other hand, a similar Republican who voted against the Republican plan might have just taken a modest step toward electoral survival.
How much of a difference could this make? It could remake the congressional map.
Imagine, for instance, that 2018 is exactly like 2010 — and to be clear, that’s by no means assured: A Republican A.H.C.A. voter who, say, won by 10 points in a lean-Democratic district does precisely as well as the average Democrat A.C.A. supporter in a slightly Republican district in 2010.
If it really happened the same way as it went for the Democrats, Mr. Curbelo might leap to the top of the list of the most vulnerable Republican incumbents in the country. Yes, he did better in his race than, say, Darrell Issa did in his California House race in 2016. But in a 2010 environment, his vote for the A.C.H.A. would combine with his district’s stronger Democratic-lean in recent presidential elections to put him in even greater jeopardy.
A candidate like Barbara Comstock of Virginia, or Mike Coffman of Colorado and Will Hurd of Texas — all “no” votes on the A.H.C.A votes — would move down the list of the most vulnerable incumbents. They’re still quite vulnerable in a 2010-like political environment, even more than they were in 2016. But they’re now armed with pretty good evidence that they’re not Mr. Trump clones or the typical congressional Republican, at least not on the defining issue of the year’s elections.
This is a distant hypothetical, not a prediction. But many effects of the new health plan could hit before the midterms. If those changes are wrenching to too many people, it is certainly possible that the Republican grip on the House will be in serious jeopardy — and that a lot of members have just cast votes that could define their career.
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