Left to right: Rep. Patrick Meehan, Rep. Ryan Costello, Rep. Brian Fitzpatrick, Rep. Charlie Dent. All four PA GOP congressmen voted against the AHCA.

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Across the country, just 20 House Republicans defected from their own party and this week voted against a party leadership-endorsed plan that vastly changes the American healthcare system. Of those 20, four were from Pennsylvania. And a quick look at our state’s electoral map shows why.

Let’s first take a look at how every congressman in Pennsylvania (yes, they’re all men) voted on the American Health Care Act, which you can see a full round-up of here. Of Pennsylvania’s 18 congressmen, five are Democrats. All five of them, including the three who represent portions of Philadelphia, voted against the bill.

That leaves 13 Republicans. Nine of them voted “yes,” while four — Rep. Charlie Dent, Rep. Patrick Meehan, Rep. Ryan Costello and Rep. Brian Fitzpatrick — voted against it. All four also represent districts in southeastern Pennsylvania that were either won by Democratic presidential candidate Hillary Clinton, or narrowly won by President Donald Trump.

Below is a map showing how each congressional district voted for president in 2016. The closest districts are purple, while blue districts were won by Clinton and red districts were won by Trump. Click on each district to see who that representative is and how he voted on the legislation.

We can break it down further by looking at each GOP congressman who voted against the AHCA and why. Let’s start with Costello and Meehan — they’re the only two Pennsylvania GOP congressman who represent districts that were won by Clinton. Both of them voted “no.”

U.S. Rep. Patrick Meehan (R-Pa.) on Memorial Day 2016. Credit: Jenna Eason

Meehan, once rumored to be considering a run for higher office, represents the 7th congressional district, which includes the Philadelphia suburbs and parts of Chester, Montgomery, Delaware and Lancaster counties. He said he voted against the AHCA because he had concerns about raising premiums for people with pre-existing conditions.

Meanwhile, Costello, who represents the 6th congressional district that covers parts of the Philadelphia suburbs north and west of the city, expressed similar concerns. He’s repeatedly brought up issues he has with the AHCA not adequately protecting those with pre-existing conditions and said amendments to the bill didn’t change his mind.

“Protections for those with pre-existing conditions without contingency and affordable access to coverage for every American remain my priorities for advancing health care reform, and this bill does not satisfy those benchmarks for me,” Costello told Politico. “I remain a no vote on this bill in its current form.”

Costello and Meehan weren’t the only GOP congressmen from Clinton-won districts that voted “no” on the bill, but it wasn’t an across-the-board choice. According to a whip count from The New York Times, there are 23 Republicans from districts won by Clinton, and just nine of them — including Meehan and Costello — voted “no.”

The two other GOP congressmen from Pennsylvania who voted “no” on this bill also happen to represent pretty purple districts. Fitzpatrick hails from the 8th congressional district that includes parts of Bucks and Montgomery counties, where Trump collected 48.2 percent of the vote to Clinton’s 48.0 percent of the vote. He voted against the bill, saying there wasn’t sufficient funding for opioid addiction treatment and recovery programs.

Dent, who represents the Lehigh Valley’s 15th congressional district, is also the co-chair of the “Tuesday Group,” a collective of moderate House Republicans. He voted against the bill and was outspoken against it for a number of reasons, including concerns about slashing Medicaid. But Dent’s also from a relatively purple district where Trump won with just 51.8 percent of the vote. (The district went 44.2 percent for Clinton.)

The conclusion we can reach from this map is that, at least in Pennsylvania, every GOP congressman who voted “no” on the bill happened to come from a district either won by Clinton or narrowly won by Trump.

But it’s not the same the other way around. There was one outlier. Rep. Lloyd Smucker, a freshman congressman, represents the 16th congressional district, which includes parts of the southeastern part of the state like Lancaster, Chester and Berks counties. Smucker voted in favor of the AHCA, though according to our calculations, he’s from what the 2016 election results would call a relatively purple district that elected Trump by about six points.

A glance at history provides some perspective. Even through redistricting over the years, the 16th congressional district hasn’t elected a Democrat to serve in Congress for more than six decades.

Anna Orso was a reporter/curator at Billy Penn from 2014 to 2017.