Paul Ryan and Donald Trump could not afford to lose another battle over healthcare in the House. Ryan had to show that he could lead his own party and Trump had to make good on his campaign promise. He also had to prove that his executive branch has influence in Congress. Ryan and Trump are now celebrating, but it may be a Pyrrhic victory. Essentially, they replaced Obamacare with a plan the greatly reduces healthcare benefits for millions of citizens. That is a good thing for many Republicans who prefer a less active government. On the other hand, taking benefits away from people is usually not politically astute. The Republican Party has had better luck with tax policy. Nobody likes to pay taxes. Its hard to lose by giving most of the public a little cut in their taxes while giving much larger cuts to people like Donald Trump. Everyone is a winner. The healthcare bill is a different story. There will be millions of losers. The CBO concluded that the prior bill, which was more generous, but failed to win support from the Freedom Caucus, would cause 24 million citizens to lose healthcare coverage. More will lose coverage under this less generous bill. Some of the losers may be upset.
The Senate must confirm the House bill in order to turn it into law. There is little chance that the bill, as written, will become law. The Senate will have to make changes in the bill in order to win support from Democrats. The vote was so close in the House that any changes proposed by the Senate will make things tough for Paul Ryan. As a last resort, there are not enough Republicans in the Senate to overcome a filibuster by Democrats. There is no way that the House bill will become law. On the other hand, Republicans in competitive districts, who voted for the House bill, will have a tough time defending their vote. Democrats will have the great majority of healthcare providers and their organizations behind them. They know that the bill is huge step backwards.