While President Trump has accomplished a lot in his first 100 days when it comes to deregulating the economy through executive action and challenging the legitimacy of government institutions -- part of Steve Bannon's mission to "deconstruct the administrative state" -- the legislative front has just sounded like crickets. President Trump has been incredibly ineffective when it comes to moving bills through the House and Senate. Most of the marquee items from the campaign have stalled.
This is his first real test, and it's a doozy. Repealing the Affordable Care Act has been a centerpiece of Republican politics since the legislation first passed. From day one Republicans have been aiming their political guns at this bill, promising to get rid of it one way or another.
The legislation has become a symbol for his foes of everything that they believed was wrong with President Obama. The extreme rhetoric that the GOP has used to describe this program has painted the policy as the source of all that is bad in health care. During his campaign, Donald Trump was a fierce opponent of ACA and promised to get rid of "Obamacare" if he won.
Well he did and now is his chance. President Trump has thrown his support behind the plan put forward by Speaker Paul Ryan, which would eliminate much of ACA (keeping a few parts, such as allowing people under 26 to stay under their parent's coverage and the ban on discriminating against people with pre-existing coverage) and replacing it with a system of tax credits that will allow Americans to write off the costs of their insurance.
For President Trump, the health care vote expected Thursday means everything.
On Tuesday, using some of the skills he honed on "The Apprentice," the President warned Republicans that if they voted against the bill they would lose their seats in 2018. He reportedly told North Carolina Republican Mark Meadows that he would "come after you
" if Meadows stood against him.
Should the House pass the legislation despite all of the conservative Republican and liberal Democratic opposition, the vote would be a sign that President Trump does have the power to put together a winning legislative coalition.
By delivering on his campaign promise, even with legislation that is not perfect, he will be able to spin the victory -- should it survive in the House -- as proof that he is in fact a Reaganite leader who is moving forward with the conservative agenda. He would be in much stronger position to move forward quickly with the rest of his agenda, including his draconian budget that would leave most domestic programs reeling.
A loss would be devastating for Trump. With the "Russiagate" investigations accelerating through Congress and the FBI, a loss on health care would signal to many Republicans that this president might not be worth standing by for much longer.
If he doesn't not have the political strength to push enough Republicans behind a major piece of legislation and if he can't actually deliver on his legislative promises, more Republicans will be hesitant about giving him more support.
When they deposed former Speaker John Boehner, Freedom Caucus Republicans showed that if they believe one of their leaders no longer support their purposes, they are willing to go to the mat to bring them down. Without a winning vote this week, and with his national approval ratings low, Trump would find himself to be more vulnerable than ever before.
For Speaker Paul Ryan, the vote is just as important. From the moment that that he agreed to take this job he knew that he had a difficult task ahead. Although Republicans are pretty disciplined as a party, the radical outlook of the Freedom Caucus makes it difficult for the Speaker to keep everyone on the same page. And now he is dealing with a situation where Democrats are much more energized and mobilized than ever before to cause problems for the GOP and with a president, who most Democrats believe to be dangerous, sitting in the Oval Office.
While a win would offer clear evidence that Ryan knows how to do his job as Speaker, a loss will erode his credibility with the White House, energize Freedom Caucus Republicans who are unhappy with the compromise he proposed, and leave Democrats feeling much better about the damage they can cause the majority party.
If the legislation passes it will instantly intensify the pressure on Senate Majority Leader Mitch McConnell. He will face even more Republican opposition to the plan in the Senate where many colleagues are not happy about the cuts to health care coverage for the poor. McConnell also needs to deal with Democrats who have many more tools as a minority than in the House. A victory in the House will therefore turn into a test of McConnell's ability to push through a bill.
For congressional Democrats, the stakes are huge as well. This bill would strike a direct blow to President Obama's legacy, even if the replacement retains more of the Affordable Care Act than the right was hoping it would. ACA is the main part of Obama's legacy and repealing much of it would present a blow to Obama, and to his party, from which it would be hard to recover.
Democrats also know that a win for President Trump would provide him with significant momentum to succeed in other areas of policy that would be devastating to their agenda. The passage of the Republican health plan, as the CBO estimated, would also result in millions of constituents losing their health care coverage.
But a defeat of the plan would put the party in a much better position, not only to keep ACA intact but to stave off the other legislative proposals that are still on their way. It would also be an important blow to President Trump at a moment the entire White House is struggling to stand its ground.
Of course this could be a case where a short-term defeat for Democrats turns into a long-term victory. If Trump gets the bill, and the results of repealing ACA are as disastrous as many experts predict, this could turn into a huge liability for the entire Republican Party by 2018.
While most talk of game-changing moments in Washington is overblown, the House vote on ACA is a decision that lives up to that billing.
Every key player in Washington will be watching closely tomorrow, realizing that the vote has huge implications for the health care of millions of Americans and will likely have important ripple effects on the standing of President Trump and the Republicans in the battles that are ahead.