Republican health care

From CNN quoting a 'Senior House Republican"

"Clearly, when you have a big majority, there are people in tough districts who need to vote 'no,'" the GOP House member said. "However, there appear to be a lot of folks who aren't in tough districts who are still voting 'no.' "

Hard to get my head around this.  So if you are in a district that is heavily Republican, you can still comfortably screw people out of quality health care without consequences?  But if you may have to face the voters in a non-trivial way, you better not?

Apparently part of the fight is that those with pre-existing conditions are still covered but the states can opt out of this.  So how would I feel if my state officials opted out of this deal so now I either
a. cannot buy a plan or
b. it costs a ton of money
because we all have pre-existing conditions.