Brian Fitzpatrick, a Pennsylvania Republican who is one of the most moderate in his party, was a surprising 'no' vote against advancing the bill. Unlike other Republicans who have voted 'no' and are now being courted in person by House Republican leaders, Fitzpatrick raced off the floor and away from the chamber after he voted no.

Republicans representing districts with high Medicaid enrollment rates could face losing their seats in the 2026 midterms.