All 14 Republicans in California's congressional delegation voted Thursday to dismantle Obamacare, a move that could have ripple effects for the midterm elections 18 months from now as Democrats sense an opportunity to win back House control.
Half of the 14 represent districts that backed Hillary Clinton for president last fall, and Democrats already are plotting to oust vulnerable Republicans on the same topic that swept them out of the majority following the 2010 Affordable Care Act vote.
The American Health Care Act, which government estimates have said could lead to 24 million fewer Americans with health insurance and could substantially affect both those on Medicaid and those with employer-provided insurance, passed the House, 217 to 213 — with all support coming from Republicans. Some of those in California's delegation voted for the bill with more reluctance than others.
Some members of the California GOP left town, while others headed down Pennsylvania Avenue for a Rose Garden photo op with President Trump.
Reps. Jeff Denham (R-Turlock), David Valadao (R-Hanford) and Steve Knight (R-Palmdale), who are frequent targets of Democrats and whose districts are among those in California that experienced the greatest benefit from Medicaid expansion, lay low after the vote.
Rep. Darrell Issa (R-Vista), who publicly said he was undecided all week and who won reelection with fewer than 2,000 votes, sat in the front row at the White House celebration. A few feet away, Rep. Mimi Walters (R-Irvine) smiled on as Trump spoke. It's a photo op Democrats are sure to use in campaign ads against the Republicans come November 2018.
Both of their districts have seen an uptick in registration among Democrats and "no party preference" voters over the past four years, and voters in each backed Clinton in November.
House Democratic Leader Nancy Pelosi (D-San Francisco) warned Republicans that they will be "tattooed" with the bill. As the final vote tally was announced, Democrats taunted colleagues with a refrain of "Na Na Hey Hey Kiss Him Goodbye."
There are 23 Republicans nationwide who represent districts that sent a Republican to Congress but picked Clinton for president. Of those, 14 voted for the healthcare bill.
Walters, an early supporter of the bill, said in a statement that she was living up to a promise to "ensure all Americans have access to an affordable, patient-centered healthcare system."
Issa said his constituents are looking for relief from Obamacare, and the vote was "the time to make it right."
For weeks, dozens of people have protested outside their offices in opposition to the bill.
Denham, the only California Republican who had said he would vote against the bill, was one of the last members to leave the House chamber after the vote. He told reporters that he got a commitment from GOP leaders that they will work on access to health care, especially in rural areas. In his office, staffers busily answered phone calls.
Denham and Valadao got into a public spat with Gov. Jerry Brown about access and Medicaid reimbursement rates shortly before the vote. Brown called them out by name for supporting the bill, and they accused the governor of hurting their Central Valley districts.
Valadao, who was rushing to an elevator outside his office with a rolling suitcase, would only refer a reporter to the statement his office sent out: saying the bill will stabilize the American healthcare system.
Knight, considered among the vulnerable lawmakers in the Golden State, said politics weren't his consideration. "If you are going to lead then you need to make decisions that are difficult," he said.
"You've got to look at what's best for the country, and this is a better policy for the country," Knight said after the vote. "If you are just looking for yourself then I'm sorry."
The healthcare bill was the final vote in the House for the week, and Rep. Ed Royce of Fullerton was among the Republicans who headed to the airport quickly after. Democrats have their sights on his district. In a statement, he called the bill a step forward to address raising costs and fewer choices.
In the Rose Garden, Trump lauded House Majority Leader Kevin McCarthy, calling him by his first name. McCarthy was integral to getting moderate members on board with the bill, finally telling them Tuesday that it was time to stop debating what the legislation should look like and vote.
"What a great group of people, and they're not even doing it for the party; they're doing it for this country because we suffered with Obamacare," Trump said as a few dozen lawmakers stood behind him.
Before the White House news conference had even ended, the national Democratic Party had launched a campaign criticizing lawmakers from the seven California districts they are aiming to flip. ActBlue, a Democratic fundraising arm, said it raised more than $250,000 nationally in the first two hours after the vote.
California billionaire Tom Steyer, who leads climate change group NextGen Climate, announced a campaign against "the Republicans who voted to hurt families and senior citizens in their own districts will be held accountable."
The National Republican Congressional Committee sent out statements thanking five California Republicans for "keeping [their] promise to protect families in his district from Obamacare's crushing effects."
Members will have an immediate chance to hear how constituents feel about the vote while they are back in California all next week for recess.
None of the Republicans have town halls scheduled, but activists plan protests and other events outside their offices. Walters' constituents have invited her to attend a town hall they arranged Tuesday on her behalf.
Millions of Californians would lose health insurance if the GOP bill is adopted, experts have estimated, largely because 1 in 3 residents are covered by Medi-Cal, the state's Medicaid program that expanded under Obamacare. Federal funding for that expansion would start phasing out in 2020, leaving states to foot the bill or drop poor people from Medicaid rolls. It faces an uphill battle in the Senate.
Times staff writer Lisa Mascaro contributed to this report.
Follow @sarahdwire on Twitter
Read more about the 55 members of California's delegation at latimes.com/politics