Since the House of Representatives passed the American Health Care Act (AHCA), it has become increasingly clear how much damage it would inflict on average Americans. A recent report from the Congressional Budget Office (CBO) showed that the legislation would cause 23 million people to lose health insurance, doubling the number of uninsured by 2026. In the long-term, the plan would hurt elderly, sick, and low-income Americans the most, according to the report.

The CBO report came three weeks after the House hurriedly passed the measure before the budget agency had the chance to estimate the costs, and to investigate how the legislation would affect Americans. This unusual step allowed Republicans to squeeze the plan through before most Americans understood the full implications of the measure. In an effort to undo the legacy of the Obama administration, the Republicans are now preparing an attack on everyday working Americans, many of whom have no alternatives when it comes to healthcare. The AHCA is not only a moral mistake, bit also a strategic political mistake for Republicans, who won the White House with a campaign that took a relatively centrist approach to issues like social security and healthcare.

During his campaign Trump often tacked somewhat to the left when it came to these issues, relative to the GOP establishment, in an ultimately successful plan to appeal to moderate working class voters in key swing states. Early in his campaign, Trump boasted on Twitter “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.” However, the CBO report found that the AHCA would cut the Medicaid budget by 880 billion. At one point in the leadup to the election, Trump advisor Kellyanne Conway said of the Trump campaign: “We don’t want anyone who currently has insurance to not have insurance.” Yet, the CBO report projects that 24 million people will lose coverage under the new plan.

Even now, Trump seems to be confused about his plans, Tweeting on Sunday that “I suggest that we add more dollars to Healthcare and make it the best anywhere.” Trump’s own budget plan, which was assembled by Mick Mulvaney, Office of Management and Budget Director, calls for cuts to future Medicaid spending, totaling between 800 billion and 1.4 trillion dollars, in a stark contrast to Trump’s Tweet. If the Tweet represents an attempt by Trump to distance himself from the budget cuts and the AHCA, he will need to take a stronger, more definitive stance on the issue.

Polls have shown Americans are largely opposed to the plan. In a poll released earlier this month, 56 percent of voters disapproved of the AHCA, while only 21 percent favored the plan. Sixty six percent generally disapprove of Trump’s handling of healthcare. Nearly half, 48 percent, of Republican voters disapprove of the legislation. House Republicans have already begun to witness the blowback from their unpopular attack on healthcare. Few representatives who voted for the AHCA held public events on their recess after it was passed on May 4th, but those that did faced angry crowds, and voters who promised to vote them out as soon as possible, with some facing reelection next year.

In the few days immediately after the House passed the AHCA, the non-partisan “Cook Political Report,” predicted another 20 seats would move to the Democrats. The Democratic Congressional Campaign Committee said they plan to contest over 100 seats in the House, instead of 45 or 50.

To become a reality, the ACHA still needs to be passed by the Senate. In the House, every Democratic voted against the measure, as well as 20 Republicans. In the senate, even Republicans have admitted it is unlikely to pass without major changes to the legislation. Senator Bob Corker of Tennessee said there is “zero chance” the AHCA will pass the Senate as-is. Some pundits have even suggested that moderate House Republicans voted to pass the bill to generate a short-term victory for the party, knowing full well that the Senate would kill the bill, limiting the long-term political fallout.

However, even if it fails to pass, the political damage may already be written in stone. These moderates may have underestimated voter’s reactions to their votes. Though a lot can change in the year and a half before the midterm elections next year, voters have a history of remembering attempts to radically change healthcare. After the Clintons attempted to put forward a health plan in 1993 and 1994, which never even received a vote, the Democrats lost control of both the House and Senate in the 1994 midterms. An estimated 27 percent of Americans under 65 have pre-existing conditions, putting them into a high-risk pool, for which the AHCA would allow insurance companies to charge more for coverage. These voters are likely to remember the House votes when they go to the polls next year. Particularly vulnerable will be representatives from 23 congressional districts that voted for Hilary Clinton last November.

Once again, Republicans are likely to find that catering to their base, considered to be around 35 percent of voters, will anger the 65 percent of Americans who do not share hard-right views. This is especially true on an issue such as healthcare, which voters tend to take to heart. This could have broad implications for the 2018 elections, and if Trump is not careful, for 2020 as well.

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