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Conservatives in the House Freedom Caucus have shouldered the majority of the blame for the GOPs failure to repeal and replace the 2010 health care law, but moderates may beequally if not more responsible for the impasse.

There are arguably more hard no votes (members not likely to be convinced to move to yes) for the GOP leaderships plan among moderate Republicans than there are among the members of the Freedom Caucus.

The Freedom Caucus, however, is the easier scapegoat. Many of the caucuss members vote against leaderships plans more often than members from other factions of the GOP conference. But on this issue the moderates have more to lose.

Several Republicans described health care as a deeply personal issue in their explanation forwhy its so difficult to find conference agreement over a single plan.

If you buy that rationale, it helps explain why moderates arent jumping on board with leaderships bill like they have with measures to fund the government and raise the debt ceiling. They can logicallyexplain voting for compromise legislation that keeps the government open or the nation from defaulting on its debt.

But a similar rationale does not exist in the case of health care. Moderates are having trouble finding a logical reason to vote for a bill that would result in 24 million people not having health insurance.

Politically, repealing the 2010 health care law is a murky issue in many of the swing districts that moderate Republicans represent. If they vote for a repeal bill without a viable replacement to protect their constituents health care, they could face losing their 2018 re-election races.

Moderates who are supportive of the heath care bill understand the dilemma many of their colleagues face.

Theyre in states that are fairly liberal in their thought process to the role of government related to health insurance. Theyre in states that expanded Medicaid. Theyre just very different parts of the country, New York Rep. Chris Collins said last week.

Collins and his fellow New York Republicans are largelymoderates from a state that expanded Medicaid, but most of their concerns were allayed with the addition of a provision to exempt New York counties from contributions to the states Medicaid program. That addition, which Collins and Rep. John Faso helped secure, is one of the reasons Rep. Dan Donovan will likely never vote for the bill. The Collins-Faso provision does not apply to New York City, which Donovanrepresents.

Then theres New York Rep. John Katko, who promised his constituents he would not vote for a bill that repeals the health care bill unless there was an adequate replacement offered at the same time. He explained in a statement that the GOP plan does not provide adequate market-based options for insurance access nor does it address skyrocketing costs.

Two no votes among New Yorks nine GOP members is still a lot of division for astate that effectively secured an earmark to win its members support. In other delegations, the divide is even greater.

Four of five New Jersey Republicans announced they would vote no on the bill, positions which they appear to still hold. The states sole supporter of the bill is Rep. Tom MacArthur, co-chair of the moderate Tuesday Group. MacArthur has become the de facto negotiator for moderates that are willing to support the bill, whilethe groups longtime co-chair Charlie Dent of Pennsylvania remains unlikely to flip to yes.

Ill listen, but Im still a no, Dent saidlast week.

Among a list of concerns, Dent worried that continuing to shift the policy to the right will make the legislation unpassable in the Senate.

A lot of members here dont want to walk the plank for a bill that may not ever be brought up, may not ever be passed by the Senate, Dent said before the March 23 vote on the bill was postponed and then canceled.

Vice President Mike Pence and Trump administration officials madethe rounds last week among Republican caucuses, trying to whip up support for an idea they hoped would get conservatives on board without losing any moderate votes in the process. But the White House has not focused on what may happen to the bill in the Senate. Nor has it tried to win over many of the moderates who opposed the bill.

For example, those involved in negotiations frequently refer to MacArthur when speaking about talks with moderates, and sometimes the Tuesday Groups third co-chair Elise Stefanik, but never Dent. Chief Deputy Whip Patrick McHenry last week complimented MacArthur and Stefanik for being constructive. Asked if his omission of Dent meant that he was not being constructive, McHenry said only, Hes a colleague and friend of mine.

The negotiations with MacArthur and other moderates have focused onkeeping the yes votes on board, rather than working through the hodgepodge of concerns raised by the moderate no votes.

Instead, Pence targeted the bloc of no votes in Freedom Caucus with a pitch to allow states to seek a waiver to opt out of certain insurance regulations. The proposed waivers gave the Freedom Caucus hope that their concerns were finally being addressed, but then moderate yes votes started coming out against the idea.

That see-saw effect of negotiations shifting between Republicans on the far right and those in the center has gone onfor weeks. Most members remain optimistic theyll find the right balance, but if they dont, both sides will be to blame.

There will be some people in both groups who can never get to yes. And thats ok, MacArthur said. We can lose 20-plus votes and still have this carry.

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Analysis: Moderate Republicans Also to Blame for Health Care Impasse - Roll Call