How will a replacement for the Affordable Care Act re-appear - rising brilliantly from the ashes like a phoenix, or climbing off the operating table like Frankenstein's monster, wreaking panic on the villagers? Congressman Tom MacArthur (R-3) is staking a great deal of his political capital on the former, not the latter.

Representative Tom MacArthur (asicophoto/Joy Asico)

The Jersey Shore Republican assessed the factors that doomed the American Health Care Act in a conversation with WOBM News, noting that while many colleagues had gone for shrill histrionics, he was reaching compromises with ultra-conservatives to insert tens of billions in support that was missing from earlier drafts.

Among the stipulations MacArthur ushered into the package were $60,000,000,000 in extra funding for older and disabled Medicaid subscribers, permanent coverage for everyone in Medicaid expansion with full federal matching funds, $90,000,000,000 more in healthcare tax credits for those in the 50-to-64 age range - about $6,000 per person - and $15,000,000,000 for young mothers in difficult pregnancies, substance abusers and sufferers of mental disorders.

"When it came out of committee, it didn't seem to do the things that we'd promised the American people, about taking care of needy families, and not pulling the rug out from under people," MacArthur said. "It went somewhat in that direction, but not far enough."

MacArthur said he realized that he could be "an obstructionist, and just vote 'no,' or try to make it better. I really believe there are too many obstructionists in Washington already. It's very easy just to say, 'no,' and it's very easy to brag about inaction, when, in fact, the American people elected us to act."

MacArthur succeeded in altering the bill with the support of the 54-member Tuesday Group that he co-chairs, which he describes as "more center-right, pragmatic" House members.

"All those things were meant to help people we felt were left behind. And we made progress. I don't think we're done," he said.

Throughout the years leading to the Replace-and-Repeal showdown, MacArthur never wavered from his view that ACA had components worth saving, and stuck by his goal of developing an improved version. His "aye" vote for AHCA on March 23 was his first on that side of the ledger.

"The Affordable Care Act has helped millions of people," he acknowledges. "The problem is, many more millions of people were hurt, and continue to be hurt, by premium increases that are routinely 50, 60, 70 percent...in some states, over 100 percent...and it's coming to every state. Deductibles that used to be $1,000 are now $8,000, $10,000, $12,000.

The fluctuations precipitated the flight of insurors from New Jersey, he added. "A year ago, in New Jersey, we had six - five already in and one coming in - and today, we have two."

MacArthur viewed the deadline for a vote, on the seventh anniversary of the ACA's signing, as a needless bit of artifice that meant rushing into a flawed plan, with insufficient support almost assured.

"It was a mistake. I said that to leadership. It's why I voted 'no' in the first place...I felt that process was not being set up for success. Now, we can figure out how to create a health program that does the most good for the most people."

The deadline pressure did work in one respect, MacArthur said. "There was a great deal of resistance as I, and others, fought to add what, in the end, amounted to $165,000,000,000 worth of help for the most vulnerable people. I think the time pressure helped them to accept that we weren't going to agree to some of their changes if they didn't agree to those things. We needed a few more days to get things sorted out, and that's what I think will happen in the coming weeks."

What stand out as needing attention? MacArthur agrees with the Freedom Caucus's drive to reduce overall costs. Plus, one objective of his own.

"I want to see Americans have much more flexibility in the use of the tax credits," MacArthur said. "I want to see them be able to put them into health savings accounts, and use them for deductibles, or co-pays, or a rainy day," he said, "Then, maybe buy insurance that's more meant for catastrophe."

MacArthur concedes that his 'aye' vote on March 23 now becomes spin fodder, taken without context, and possibly ammo for political retribution. "But I didn't come here to decorate a chair," he said.

"I'm not ascribing motives to anyone else. Everyone has to do what they think is right. But I can't let this become about politics for me. This is about people," MacArthur said.

"I know there's fear. But much of that fear comes out of confusion, through misunderstanding of what this bill does, and does not, do. I'm here to do what I think is right, and to represent the people who sent me here, and to try to make a difference. And that's what I'm going to keep doing."

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