News media and pundits have largely focused on what House Majority Leader Rep. Eric Cantor’s Virginia Republican primary loss to David Brat means for immigration reform, but Cantor was also heavily involved in drafting the Republican alternative to the Affordable Care Act (ACA).

A key legislative gatekeeper, Rep. Cantor was able to use his position to raise funds for himself and also fellow Republican candidates from various industries, including of course healthcare. According to campaign finance reports published by OpenSecrets.org, Rep. Cantor’s political action committee, the Every Republican is Crucial PAC, had so far this year collected $169,250 from the pharmaceuticals/health products industries, $132,300 from health professionals, $80,300 from hospitals and nursing homes, and $55,000 from health services/HMOs.

He had been vocal about his plans to help move the Republican party away from the “repeal Obamacare” message, which had not been working with more moderate voters, and onto a “replace Obamacare” message that he saw as key to the party’s success in this year’s midterm elections.

In February, Cantor stated in a CBS “Face the Nation” interview that he believed healthcare would be a winning issue for the GOP in the 2014 midterms. Along with Rep. Dave Camp (R-Mich.), chairman of the Ways and Means Committee; Rep. Fred Upton (R-Mich.), chairman of the Energy and Commerce Committee; and Rep. John Kline (R-Minn.), chairman of the Education and the Workforce Committee, he was working on a bill that could be introduced as an alternative to Obamacare.

However, Brat successfully tapped conservative voter frustration about the failure to repeal the ACA and insinuated that Cantor was perhaps secretly supporting Obamacare. A vote earlier this year in favor of extending the debt ceiling without strings attached, like the defunding of the ACA, was portrayed in Brat campaign commercials as Cantor having voted to continue funding the ACA.

If conservative politicians back off of immigration reform over fears that what happened to Cantor could happen to them, they may also become equally vary of working on making necessary improvements to the ACA or touching healthcare spending issues in any manner short of demanding outright repeal of Obamacare. Introducing their own plan was already a tough as polls have shown that while Obamacare is unpopular, many of the provisions within it are well liked by voters.

Adding another layer to the picture is that how healthcare lobbying is conducted is a hot topic at the moment. The insurance industry has been criticized in the media for being overly successful in its efforts. Meanwhile the American Medical Association membership has begun to express its frustration over its own perceived lack of influence. The AMA's all-out effort to permanently repeal the sustainable growth rate (SGR) formula came up short once more in March and the membership voted this week to create an annual review of its political efforts.

Of course, the coming fight over who will occupy the House leadership positions will make it even more difficult than usual to know which legislators would be best to concentrate lobbying efforts on, and only after the dust settles will it be clear what the best lobbying strategy would have been. Hindsight is 20/20.