Trump finally wins on health care, but still faces a long slog

President Trump got his first big Hill victory yesterday when the House passed a convoluted compromise on replacing ObamaCare.

But it’s not clear it will ever become law.

The president got his way on making sure people with preexisting medical conditions remain covered, but the rushed and messy nature of the deal means even that is in dispute. An $8-billion amendment enabled Trump to bridge the gap between conservative Republicans who wanted a clean repeal and moderates worried about millions being kicked off the insurance rolls.

The way Washington scores these things, it’s a win. And Trump sure was upbeat at the White House yesterday.

Still, I wouldn’t bet a whole lot of money on this bill passing the Senate, at least not in this form.

What is also clear is that Barack Obama, with his much-derided legislation seven years ago, changed the terms of the debate. Ignoring the current ban on preexisting conditions, a central feature of the former president’s law, was not deemed by Republicans to be a viable option.

Politically, Trump needed to put some points on the board. The failure of the House to vote on the original bill was perhaps the biggest setback of his presidency. Now he and Paul Ryan can say they delivered a down payment on their promise to throw out ObamaCare.

By the way, the process was so ugly that the House doesn’t even have an official estimate of how much the bill will cost—precisely the sort of thing for which Republicans once rightly bashed the Democrats.

When they fiddled with the original bill to allow states to opt out of the preexisting mandate—if they created high-risk pools for those not covered—they lost some moderate votes. The extra $8 billion provides cover for less conservative Republicans who want to make sure those with prior illnesses aren’t priced out of the market by sky-high premiums.

Many analysts say that $8 billion isn’t enough and that many people will face unaffordable price hikes. And that and other extra money runs out after a few years.

Any Senate bill is virtually certain to tilt more toward protecting and subsidizing patients, underscoring why reforming health care is such a slog.

But let’s say the measure gets bottled up in the Senate.

On the one hand, conservative voters would be justifiably angry that the GOP controls everything in Washington but failed to deliver on one of its signature promises.

At the same time, Trump could blame Chuck Schumer and perhaps some Senate Republicans. And the GOP would be insulated from any real-world fallout that might occur if millions lose their coverage or can no longer afford coverage.

For now, though, Trump is triumphant, silencing critics who say he doesn’t know how to deal with Congress.