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President Donald Trump this week faces the biggest legislative challenge of his presidency, as the House of Representatives prepares to vote on the Republican replacement for Obamacare.
Termed the American Health Care Act, the proposal was unveiled just over two weeks ago by Republicans, led by House Speaker Paul Ryan and with the backing of Trump.
When not batting away the latest controversy over his campaign team's ties with Russia, Trump has thrown himself into the role he knows best – striking deals – trying to coerce sceptical Republicans to back the deal, and threatening to make life difficult for them when it comes to next year's mid-term elections if they do not back the proposal.
Much of the feverish discussion taking place in Congress over the last two days is a typical case of political bargaining.
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Already some individuals have successfully extracted concessions – New York Representative Claudia Tenney gave her backing to the Bill after successfully lobbying for an amendment which will shift the cost of Medicaid coverage from counties in New York to the state government – a controversial move in her home state.
On the eve of the vote, however, significant opposition remains. In particular, Trump and Ryan’s main adversaries are a conservative block of Republicans, mostly members of the so-called Freedom Caucus in congress, who oppose the Bill on the principle it constitutes a form of state subsidy by including a system of tax credits.
Loss of healthcare coverage
Even if approved in the House, the proposal is likely to face opposition in the
Senate
where republicans are demanding changes, including from moderates who fear that many of their constituents may lose protections granted by Obamacare. A devastating report from the Congressional Budget Office last week found that 14 million people would lose their coverage next year under the proposal, while the number of uninsured would rise to 24 million by 2026.
But the success or otherwise of the American Health Act has wider repercussions. Uncertainty about the healthcare proposal pushed stock markets in the US and Europe to their lowest levels since Trump's election last November, reflecting market fear that failure to follow through on healthcare reform could impact other tax and infrastructure changes pledged by the US president.
Trump himself used a rally in Kentucky on Monday night to rouse support for healthcare change among his constituents, arguing that it could then pave the way for long-promised tax changes.
By hinging his promised tax reform and infrastructure plan on first dealing with a replacement for Obamacare, Trump has put a lot riding on his much-heralded promise to repeal and replace his predecessor’s healthcare reform. This week may show if this gamble pays off.