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.

Both parties feel a sense of urgency to enact their agenda if they win the White House, House and Senate. But there are downsides to a very big bill.