President Trump is facing fresh political challenges on healthcare after squandering Obamacare's unpopularity on a Republican alternative the voters like even less.
Trump is pressing Republican allies in Congress to pass the American Health Care Act, encouraging them to make whatever changes are necessary to advance a package that repeals and replaces Obamacare in a bid to reduce premiums and increase choice.
But in a stark reversal after years of political advantage, the president and his party are on the defensive on healthcare with the majority of voters, public opinion polls show.
The evolving Republican bill is hampered by sharply low ratings, while appreciation for the troubled Affordable Care Act is on the rise.
That points to trouble ahead if Trump and Republicans on Capitol Hill can't reset the health care debate as they head toward pushing through reform legislation on a party-line vote, as the Democrats did before them.
"Somehow, the Republicans are going to have to come back and find a way to re-introduce their health care plan," GOP pollster David Winston said Thursday in an interview with the Washington Examiner.
Dissatisfaction with former President Barack Obama's health care law, and the partisan muscle used to enact it, were crucial building blocks of today's Republican majorities in Congress. The GOP won two wave midterms after Obamacare passed, plus the 2016 contest.
The equation has changed. The Affordable Care Act is enjoying extended popularity for the first time since it was enacted in 2010, a political recovery that began after Trump assumed office and accelerated in March after repeal legislation was introduced in the House.
More Americans now approve of the troubled law (49.1 percent) than disapprove (42.4 percent), according to the RealClearPolitics polling average that stretches from late April back to early February. In a recent ABC New/Washington Post poll, 61 percent of Americans favored keeping Obamacare.
Even Republican voters, who still favor repealing the ACA, including in this new poll, expressed support for maintaining many of the coverage protections guaranteed under Obamacare, such as one that prohibits insurers from denying coverage based on a pre-existing medical condition.
The current, amended version of the American Health Care Act would allow states to decide whether to maintain those provisions. With their Obamacare experience in mind, Democrats are salivating over the political opportunity passage of the Republican bill might provide in 2018.
"I want every Republican on record in support of Trumpcare," Democratic strategist Matt Canter said.
The Trump White House — echoing the Obama administration's ultimately false reassurances about the ACA — is insistent that that GOP health care bill will grow in popularity after it is signed into law.
"We strongly believe that the American Health Care Act, which will lower costs and increase access to care, will be well received by the American people," a White House aide told the Examiner in an email exchange.
House Speaker Paul Ryan, R-Wis., said the GOP has no choice but to take a risk and vote for it. "I think people's seats are at risk if we don't do what we said we would do," he said. "If you violate promise, if you commit the sin of hypocrisy in politics, that's the greater risk, I think, to a person's seat."
Trump is in a pickle.
Replacing Obamacare with conservative reforms was a major campaign promise that Republican voters expect him to deliver on. Abandoning the policy in favor of fixing and strengthening the current law would cause the conservative base to revolt.
Because Obamacare will collapse absent repairs, leaving Americans with ever-rising premiums and few care options — and leaving Trump to take the blame, his only option is to overhaul the system and hope it works out better for than it did for his predecessor.
A GOP strategist and veteran of campaigns while the party was winning seats because of Obamacare said that Republicans still has a chance to win the healthcare debate if they can change the way they talk about it. Republicans, this insider said, have to talk about care and how their bill would help people.
"All we have been doing is fighting and talking process," the strategist said, on condition of anonymity in order to speak candidly.
This Republican consultant and others who track the polling credited GOP infighting on health care, and the poor messaging used to promote the American Health Care Act, for Obamacare's resurrection.
There's data to back that up.
In an early April Gallup poll, 52 percent of Democrats favor making significant changes to the law. Meanwhile, Republicans who have opposed the AHCA at various points over the last two months have joined Democrats in badmouthing it.
It's hard to build support for legislation when all voters here are bad news. That dynamic, still playing out as moderate and conservative Republicans debate changes to the law was magnified by the Congressional Budget Office.
The original version of the bill was scored by the CBO as leading to millions of uninsured Americans and doing nothing to lower premiums. Republicans say that narrative has to be countered, or voters will assume it's true and make the party pay.
"How hard could it be to find some families or small business owners to roll out with facts and hard numbers and provide some third-party credibility?" a Republican strategist said via email. "Under Obamacare our premiums went up by $X. Under this plan, we'll save $X per year."