The Blue Dogs aren’t the only members of Congress sweating their vote on health care reform as Congress prepares to go into recess. Congressman Joseph Cao of Louisiana won’t have a very relaxing August either.

Cao represents New Orleans and Jefferson Parish, the most Democratic district held by a Republican congressman. Before his upset victory last November, New Orleans hadn’t sent a Republican to Congress since 1891. The Vietnamese-born Cao was able to slip into the seat in large part because he was running against incumbent William Jefferson, who was being indicted on federal corruption charges during the campaign.

President Obama carried this district with nearly 80% of the vote last year. The economically depressed and hurricane-battered area reports a median income just above $25,000. Currently, the district is 64.1% black and only 10% of registered voters are Republicans. In this economically liberal climate, Cao is under serious pressure to buck his party and vote with the president on health care.

But Cao faces mounting pressure from the Republican Party as well due to his heavy reliance on the conservative base for financing. In the last quarter, he has been a leading GOP fundraiser with $370,000 raised in large part due to the Patriot Program, a project by the National Republican Congressional Committee designed to raise money for vulnerable Republican incumbents.

According to opensecrets.org, Cao has generated thousands in donations utilizing the help of solid conservatives and their political action committees. Such donations include $40,000 from Pete Sessions for Congress, an additional $5,000 from Sessions’ PAC, People for Enterprise Trade and Economic Growth; $9,500 from former Congressman Bob Livingston’s lobbying firm, Livingston Group; $2,000 from Friends of John Boehner; and $2,000 from Friends of Jeb Hensarling. Sessions, Boehner, and Hensarling have all received 100% ratings from the American Conservative Union.

Sessions and Livingston ranked 1st and 3rd, respectively, as Cao donors. Also a top ten donor was the Committee for the Preservation of Capitalism. If Cao votes for the health care bill, with its increases in taxes and spending, he may lose the financial support that he will likely need in order to compete against a Democratic challenger in 2010.

At an AAA healthcare event in New Orleans, on July 1, Cao said “the majority of the district does not have sufficient healthcare… we are working extremely hard to find the necessary federal funding.” On July 23, Cao’s communications director, Princella Smith, told TAS that Cao had not yet taken a position on the health care vote and was still reading the bill. The bill had been made public on July 14.

The congressman faces possible votes on several controversial provisions. The Republican voters and donors don’t want him to raise taxes. Cao has stated that he does not want to add to the deficit. The House Democratic bill does both. Furthermore, because the bill mandates abortion coverage, the congressman may need to oppose it on pro-life grounds as well. Cao had been in a Jesuit seminary before pursuing politics.

Cao has repeatedly expressed his support for President Obama, scoring him an “A” when grading his first 100 days in office. When asked in a New Orleans Channel 6 interview how he identifies himself politically, he refused to call himself a conservative. Cao had been a registered independent until two years ago.

Regardless of how the congressman votes on the health care bill, he will face difficulties getting re-elected in 2010. With the daunting challenge in mind, Cao appears willing to position himself as needed in the district. He went against party lines in co-sponsoring the Hate Crimes Bill, was one of the four GOP congressmen voting for the war supplemental funds, which were stacked with spending unrelated to war (Cao said his vote was motivated by funding for Gulf Coast restoration projects). Cao has not shown a lot of shame with respect to earmarks — his district has requested three times the state average for Louisiana congressmen. While he did vote against the stimulus, he justified doing so because he said there were not enough projects included that would benefit Louisiana.

Cao is also looking for other ways to fit in. He has expressed a desire to join the Congressional Black Caucus, because only former Black Panther Bobby Rush represents a district where blacks make up a higher percentage of voters. Cao mentioned in an interview that he was told he could join, but that he would be excluded from some events due to his party affiliation. He is not yet a member.

Joseph Cao may not be a conservative standout, but he is a Republican who has won over voters who often elude the party. If his election is more than a fluke, he could help the GOP make inroads with urban voters (including urban Catholics), blacks, and people of immigrant background. But Cao’s health care vote may prove such outreach can be expensive.