THE MEMO: Trump faces long war on healthcare

President Trump won a big political battle this week, but he is facing a longer and harder war.

The victory came when the House passed legislation that would largely repeal the Affordable Care Act (ACA), or ObamaCare. It was a major step toward fulfilling a longstanding GOP promise. 

But the focus now moves to the Senate, where the push faces deep uncertainty. And the broader struggle, to win over public opinion, could be even more difficult. 

President Obama’s signature healthcare law is more popular now than it has ever been, according to opinion polls. Trump and the GOP will own any legislation that does make its way into law — and will feel the heat of voters’ blame for any shortcomings.

The president was exuberant when he spoke in the White House Rose Garden, with GOP lawmakers arrayed behind him, shortly after the House had voted. But even some Republicans acknowledge that the hard work is just beginning.  

“My gut is that the headaches for Republicans on healthcare are just starting,” said Republican strategist Mark McKinnon. “I think the Senate has already been spooked by public reaction. So they’re going to want to moderate, which will meet resistance from [Sens.] Rand Paul [Ky.] and Ted Cruz [Texas]. And they can’t afford to lose even a couple votes in the Senate. The House may have been the easy part.”

Democrats make similar points. Sen. Ed Markey (D-Mass.) told MSNBC’s Stephanie Ruhle on Friday that the GOP was “searching for a unicorn” in its efforts to craft legislation that could appeal to both its most conservative and more center-right members. “I do not think it is possible,” he said.

Other Democrats, meanwhile, insist that the political tides have turned in their favor. They highlight a Congressional Budget Office assessment that projected 24 million people would lose health coverage over the next decade under the first iteration of the GOP plan. They also make the related argument that millions of people with pre-existing conditions could find themselves priced out of the market. 

House Minority Leader Nancy Pelosi (D-Calif.) lambasted Republicans moments before the bill passed. “You have every provision of this bill tattooed on your forehead,” she warned. ”You will glow in the dark on this one.”  

Democratic Sen. Dick Durbin (Ill.) said the same day, “The vote they just cast to take healthcare away from the people they represent will be front and center when they face their constituents.”

Still, Trump may well earn some political dividend from having persevered with the healthcare effort after it seemed to be dead and buried in March, when an initial effort at House legislation ran aground. 

A Republican strategist with close ties to the White House said that the president had been deeply involved in the push to pass the new legislation. 

“He was busy corralling votes,” the strategist said, adding that, “at the same time, he is not steeped in policy.” 

“His role was making sure that Republicans understood how important it was for the president to get this done,” the source added. “Some of the policy details were delegated to others … but when you get a phone call from the president, that underscores the stakes.”

Among conservatives, meanwhile, there is near-jubilation at the passage of the House version of the bill — and a degree of scorn about Democratic warnings that there will be an electoral price to be paid.

“While it may be difficult and even painful along the way, the Republicans are steadily moving from an opposition party to a majority party,” said Keith Appell, a consultant whose firm, CRC Public Relations, worked to advance the nominations of Attorney General Jeff Sessions and new Supreme Court Justice Neil Gorsuch.

Appell argued that voters would reward lawmakers — and a president — who kept their central pledge, whereas they would be punitive if the opposite were the case. He cited President George H.W. Bush’s breaking of a famous campaign-trail pledge — “Read my lips: No new taxes!” — as a cautionary example.

Among Republican members up for reelection in next year’s midterm elections, Appell said, “there is a recognition that the base will not abide the breaking of this promise. There just aren’t enough swing voters who will break your way to make up for the base voters you will lose, if you break this promise. That’s the lesson of ‘read my lips,’ and I think they are remembering that.”

Democrats, naturally, hold a very different opinion. Many members of the opposition party took a particularly dim view of the decision by Republican lawmakers to go right away to the celebratory Rose Garden event — a move that required them to run the gauntlet of protestors outside the Capitol as they made their way to waiting buses.

“The Republicans painted themselves into a spot where they only had bad options in front of them,” said Democratic strategist Jamal Simmons on Friday. “In the end, they spent last night celebrating on their way to the lifeboats on the Titanic.”

The strategist with ties to the White House, though, was among the Republicans buoyed by the House vote, arguing that it was another piece of evidence, along with Gorsuch’s confirmation, that the president was settling into the job. 

Trump, the source said, “can put a notch there. He now has Gorsuch there, and he has healthcare having passed the House of Representatives — even if it has to become law for it to be a true victory.” 

Some Republicans more skeptical of Trump warn that everything is still to play for, however. 

“Whenever you make a change this big, you need somebody who can make the rationale for it, who can convince the public to be patient and give it time to work,” said GOP strategist Dan Judy, whose firm North Star Opinion Research worked for Trump rival Sen. Marco Rubio (Fla.) in last year’s Republican presidential primary. 

“Donald Trump has always talked about what a great salesman he is. Now is the time to prove it.”

The Memo is a reported column by Niall Stanage, primarily focused on Donald Trump’s presidency.