U.S. President Donald Trump has notched his first significant legislative victory, with the House of Representatives narrowly passing a bill to repeal much of former president Barack Obama's signature health-care law.
With part of the GOP caucus gathered behind him in the White House's Rose Garden, the President cheered his ability to unite his fractious party and crowed that the win signalled the start of big things.
"This has really brought the Republican Party together," he said. "We are going to have a tremendous four years and maybe, even more importantly, we're going to have a tremendous eight years."
But whether Mr. Trump can even get through the next 100 days without the American Health Care Act (AHCA) floundering is an open question.
He must ensure the bill is pushed through the Senate, where his party has an even smaller margin than it does in the House. Along the way, he will have to mediate between moderate senators who will likely want to soften the proposed law and harder-line members of Congress who torpedoed a previous version of the bill because it did not go far enough.
And the President faces other major tasks – including delivering on promised tax reform and starting the renegotiation of the North American free-trade agreement – that will test his ability to work with Congress.
His handling of health care revealed several traits that offer clues on how he will handle these files, including a malleability on policy details and an unwillingness to follow through on his largest threats.
The AHCA would reverse most of Obamacare's provisions. The proposal repeals rules that obliged medium and large companies to provide health insurance to their employees; turns back the expansion of Medicaid, a government-funded program that provides health care to low-income people; and scraps income-tested subsidies for people to buy health insurance, replacing them with age-tested tax credits.
To win over the hard-right Freedom Caucus, a group of GOP legislators who had previously refused to support the bill, the White House and Republican leadership added a new provision to the AHCA: States will now be allowed to opt out of Obamacare's rules obliging insurance companies to cover people with pre-existing conditions and to cover 10 specific types of health services in every plan.
But trying to undo Obamacare's most popular provisions may ultimately kill the bill itself. Twenty GOP legislators broke ranks to vote against the AHCA. And Democratic members of Congress taunted the rest of the Republican caucus by bursting into a round of "Na na na na, hey hey, goodbye" after the vote – implying that many GOP members will be shown the door by their constituents for taking away their health insurance. The Congressional Budget Office estimated in March that the AHCA would result in 24 million fewer people having health insurance by 2026 than if Obamacare were retained.
With a majority of just two seats in the Senate, it is unlikely the Republicans will have the votes to pass the bill without revisions – setting up another round of negotiations that could dominate the coming months.
"It will be a real big challenge on the Senate side as well," Majority Leader Mitch McConnell bluntly told reporters this week. Moderate Republican senators, including Susan Collins of Maine, have previously said they cannot back a bill that takes insurance away from so many people. Those on the party's right, such as Ted Cruz and Rand Paul, however, have argued the bill must fully repeal Obamacare to get their support.
What's more, Mr. Trump will also need caucus solidarity to push through what he promised Thursday would be "the biggest tax cut in the history of our country." And under the United States' convoluted rules for negotiating trade deals, he will likely need Congress's support for his overhaul of NAFTA with Canada and Mexico. The Trump administration is hoping to notify Congress of its plan to renegotiate this month, starting a 90-day countdown to the opening of talks.
The tax plan should be less politically fraught than health care because Republicans at least agree on the idea of cutting taxes, said David Lublin, a professor in American University's Department of Government. He said, however, that many of the thornier problems – such as how to pay for the cuts – have not been ironed out. And the health-care bill showed Mr. Trump was content to leave the details to others, such as Speaker Paul Ryan, to sort.
"It's unclear how much, if anything, he really did on this issue. He seems unable to keep his attention on any one issue for any amount of time," Prof. Lublin said.
Mr. Trump also revealed himself to be unwilling to follow through on his toughest threats, such as when he declared last month that he would simply cut funding to Obamacare subsidies unless Democrats in Congress negotiated with him.
Such a dynamic, however, could auger well in NAFTA talks for Canada and Mexico, which are hoping that Mr. Trump can be contented with a few small changes to the deal and will ultimately leave most of it in place.
The President cares more about being able to tell his supporters that he won, Prof. Lublin argued, than about the details of the achievements themselves.
"What Donald Trump really cares about are the optics of today," he said.
"They got something through the House and he's had his victory."