Moderate Republicans are facing a difficult decision on the House GOP’s ObamaCare replacement bill after a change to the plan increased conservative support.

The conservative House Freedom Caucus on Wednesday endorsed the revised version of the bill, leaving centrists as the GOP’s sole obstacle to getting the votes needed to pass a bill fulfilling the party’s longtime pledge to repeal Obamacare.

The Freedom Caucus’s move came after a new amendment from centrist Rep. Tom MacArthur (R-N.J.) and conservative Rep. Mark Meadows (R-N.C.) that would allow states to apply for waivers to opt out of core ObamaCare protection for people with pre-existing conditions, which conservatives say drives up premiums. 

But so far, no moderates have moved from no to yes on the bill, and some centrists have said privately that MacArthur was not negotiating on their behalf. 

Weakening ObamaCare protections for people with pre-existing conditions could even move some moderates even further away from the bill.

“Those are the kind of concerns that obviously make me have to think long and hard about it,” said moderate Rep. Ryan Costello (R-Pa.) on Wednesday.

{mosads}Rep. Charlie Dent (R-Pa.), co-chairman of the centrist Tuesday Group, and Reps. Dan Donovan (R-N.Y.), Frank LoBiondo (R-N.J.) and Ileana Ros-Lehtinen (R-Fla.) have all said previously they’re still opposed to the bill even with the changes.

House GOP leaders will very likely need to flip some moderate Republicans to get to the needed 216 votes to pass the bill. 

Speaker Paul Ryan (R-Wis.) said Wednesday the amendment “helps us get to consensus” but did not say how close Republicans are to 216 votes. 

Conservative Rep. Dave Brat (R-Va.) said he now supports the measure because of the changes. 

“Getting the prices and the premiums down, that was the big deal,” he said.  

Two influential conservative groups — the Club for Growth and FreedomWorks — said Wednesday they would support the bill if the amendment were adopted. Both had long urged leadership for a full repeal of ObamaCare but praised the amendment as a good compromise. 

Other moderates said after a Wednesday morning conference meeting that they still needed to look at the changes. 

MacArthur spoke in the conference meeting in support of the changes and received applause at the end. Meadows, the chairman of the conservative House Freedom Caucus, was the sole lawmaker to give MacArthur a standing ovation, a lawmaker said. 

The MacArthur-Meadows amendment allows states to apply for a waiver from ObamaCare’s “community rating” requirement, which prevents insurers from charging premiums based on customers’ health.

If that were repealed, insurers would be allowed to charge people with pre-existing conditions much higher premiums due to their illnesses, putting coverage out of reach for many. 

The amendment also allows states to apply for a waiver for ObamaCare’s essential health benefits, which mandate that all insurance plans cover certain services, such as mental health and prescription drug benefits. 

– Updated at 1:11 p.m.