The House of Representatives on Thursday passed a bill that would block the Trump administration from granting states the leeway to skirt Obamacare rules —- a measure designed to ensure that patients with pre-existing conditions continue to receive affordable robust coverage — in a 236 to 183 vote. The bill is not expected to pass the GOP-controlled Senate, but even if it does, the president has threatened to veto the measure.

Every House Democrat and four Republicans voted in favor of the bill, H.R. 986, known as the Protecting Americans with Preexisting Conditions Act of 2019. Meanwhile, 183 Republicans voted against it — including members who vowed in 2018 that they would protect people with pre-existing conditions.

The Department of Health and Human Services issued new guidance around the Affordable Care Act (ACA) last November that encourages states to make changes to their marketplaces even if that means skirting federal rules and putting people with pre-existing medical conditions in jeopardy of increased health care costs. The Kaiser Family Foundation called the change “significant,” as it “eliminates the requirement to demonstrate comparable protections for people with high health risks.”

A state, for example, could ask to subsidize plans that don’t cover addiction treatment, a plan that is useless for someone struggling with substance misuse. Healthier people, however, would likely gravitate toward such a cheaper plan. If enough people in perfect health flock to these less comprehensive plans, parallel markets would inevitably form based on risk posed to insurance companies. This means people with pre-existing conditions are left with plans that get increasingly expensive, especially if they don’t qualify for tax credits or cost-sharing subsidies.

So far, no state has asked the federal government to skirt ACA rules. But Reps. Ann Kuster (D-NH), Don Beyer (D-VA) and Joe Courtney (D-CT) wanted to ensure no state gets the chance by introducing the measure that advanced on Thursday. 

Republicans in Congress have demonstrated time and time again that they prioritize cheaper health plans over comprehensive ones. Yet, many have tried to distance themselves from their own voting records, especially ahead of the midterm elections. In fact, several Republican Senators introduced a bill last August called the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” that didn’t protect sicker patients as much as current health law does.

The GOP’s voting record on the ACA led the party to lose control of the House in the last election cycle. According to a Center for American Progress Action Fund (CAPAF) analysis of Senate and House races that the Cook Political Report identified as a tossup, 20 out of 25 Republican incumbents who voted at least once to repeal the ACA lost their seats. (ThinkProgress is an editorially independent news site housed at the Center for American Progress Action Fund.) Republicans who were re-elected in those tough races are still voting against the ACA.

Three House Republicans — Andy Barr (KY), Ted Budd (NC), and Scott Perry (PA) — voted against Thursday’s measure, even though they’ve vowed to protect people with pre-existing conditions.

Barr voted to repeal the ACA five times since 2013, and even voted to repeal the 2010 health law — including the provision that says insurers cannot deny patients with an existing medical condition — without any replacement plan. But he distanced himself from the record ahead of the primary.

“Republicans only will always protect patients with pre-existing conditions,” said President Donald Trump during a campaign rally for Barr in October.

“Obamacare continues to fall under its own weight,” Barr told the Louisville Courier Journal in October. “It is imperative we deliver a healthcare system that protects those with pre-existing conditions but still allows the marketplace to compete and innovate which will, in turn, lower costs and deliver relief to families throughout Kentucky,” he added.

Budd and Perry have also misled voters about their voting records when faced with criticism. Budd voted once to repeal the ACA and Perry voted to repeal it five different times.

During his 2018 re-election campaign, Budd said claims that he doesn’t support people with pre-existing conditions were false. Perry defended his record in a similar way, saying, “we repealed Obamacare and we put in the American Health Care Act to deal specifically with preexisting conditions and fix the health care system.”

While the GOP health bill wouldn’t let insurers explicitly exclude sicker patients, it did aim to make their health care more expensive. The Kaiser Family Foundation estimated that 6.3 million people could face higher premiums because of pre-existing health conditions.

Even after the election, Budd promised to “keep fighting to eliminate the harmful, costly elements of Obamacare while protecting healthcare for those with pre-existing conditions.”

Republicans appear unconcerned that their stance on health care will affect their chances in the 2020 elections. Indeed, Budd told HuffPost that the Trump administration’s decision not to defend the ACA in court is not “hurtful.”