The passage of the House version of the American Health Care Act was a vital necessity for Trump and his White House. Without it, the president’s first six months would have been written off as a meandering farce in which the paralysis that had characterized Washington over the past six years would have been extended ludicrously to a Washington in which Republicans hold both chambers of Congress and the White House. If we learned anything from the Jimmy Carter years, or from the Bush presidency from the fall of 2005 through the election of 2006, it is that the nation comes to feel contempt for a president who appears incompetent. And perhaps that would have been the case with Donald Trump most of all, since his entire candidacy was premised upon his ability to cut through the crap and get things done in a billionaire-businessman kind of way. So what happened yesterday was a big deal, even if the bill is only a third of the way through passage. It must now go to the Senate, which will amend it before it can pass there—and if it does, the House and Senate versions will have to be reconciled and then voted on again by both bodies before going to the president for signature.
Trump needed this, and he got it. The raw political question now is whether it does him far more good than it will do the politicians who provided the victory for him. To be sure, House Speaker Paul Ryan needed it almost as much, because he had to show he could manage the passage of a piece of legislation. Ryan became speaker in 2015—a post he did not seek and did not initially want—without ever having shepherded a bill through the House, and questions were being raised about his competence as well.
But what about the 216 Republicans other than Ryan who voted for the bill? The onslaught against it is furious. The flexibility it attempts to give states to manage the growth of their health-care costs has handed Democrats a giant club with which to beat Republicans about the face and neck on the question of whether the protections for “pre-existing conditions” have been removed. The general Democratic talking point—not the most extreme talking point but the general talking point—is that the bill will lead to the deaths of millions of people. This is gross and even demented rhetoric, and would once have been out of bounds, but in the Trump era it’s pretty clear nothing is out of bounds any longer. Democrats are scaring their base senseless, and ginning up a rage and fury that will cause fundraising to flow and late-night comedians to rant on camera in a manner even Jimmy Swaggart might have recoiled from as being too hot for TV.
This is going to be hard for many people who cast their votes for the bill. The major problem for them is that the genius marketer in the White House who needs to sell these changes to the American people has shown no capacity whatever to market anything outside himself.