It's "Trumpcare" now, and Republicans have to answer for it.
After dozens of symbolic votes, House Republicans finally pushed through a bill to gut Barack Obama's Affordable Care Act, with President Donald Trump hailing the replacement as "a great plan" that has "really brought the Republican Party together."
Democrats are giddy about what could be severe political consequences for the GOP.
Even though the Senate still has to act, Republicans now largely own a measure that would curtail, and in some cases take away completely, benefits Americans have embraced after seven years. Chief among them: a guarantee of paying the same amount for coverage regardless of health history. Budget analysts estimate 24 million people would lose insurance over a decade, 14 million in the first year, and older Americans would face higher costs.
The Senate, meanwhile, will write its own health care bill, Majority Leader Mitch McConnell said in Louisville while attending the Kentucky Derby. No timetable will be announced, McConnell said, and he added: "We don't anticipate any Democratic help at all, so it will be a simple majority vote situation."
In the House, 217 Republicans voted yes.
"Progressives are going to hang this around the necks of every one of those Republicans," said Angel Padilla, co-founder of the liberal group Indivisible. "These Republicans voted to take away peoples' health care. This is going to come back to bite them."
Democrats are convinced the GOP repeal bill jeopardizes the Republican monopoly in Washington, starting with majority control of the House, and the party's advantages in statehouses from Nevada to New Hampshire.
The potential fallout crystallized almost immediately.
Fundraising surged nationwide as new recruits stepped up to challenge vulnerable Republicans who backed the plan. Among the vulnerable: two-term Rep. Tom MacArthur, R-N.J., who helped revive the bill by authoring a key amendment on pre-existing conditions.
"We have an opportunity to take down the person who was the author of Trumpcare 2.0," said Democrat Andrew Kim, an Obama White House national security adviser, who said he's now more likely to challenge MacArthur next year. Kim raised more than $43,000 online over the last week for a possible run.
"He owns every part of this," Kim said of MacArthur.
Democrats need to flip 24 seats between now and the 2018 elections to take control of the House. Of the 217 Republicans who backed the bill, 14 come from districts carried by Democrat Hillary Clinton last fall, and 24 serve in districts where Trump did not win more than 50 percent of the vote.
Republican Rep. Ileana Ros-Lehtinen, who is not seeking re-election next year, warned that the bill "has the potential to severely harm the health and lives of people in south Florida." Her open seat in Miami is considered a prime pick-up opportunity for Democrats.
Next month, Democrats and Republicans face a showdown over a House seat in the Atlanta suburbs. Georgia Democrat Jon Ossoff, who is trying to score a special election upset in a traditionally conservative House district, said he strongly opposes "discrimination" over pre-existing conditions in response to the vote.
Outside groups prepared to launch an advertising campaign in the coming days to punish vulnerable Republicans in key states. The television and online blitz is expected to seize on the more unpopular provisions in the GOP plan, which was opposed by the AARP, the American Medical Association, which represents doctors, and the American Hospital Association.
The AARP warned that the GOP plan institutes an "age tax" and jeopardizes coverage for 25 million older Americans with pre-existing conditions. The bill would also roll back subsidies for individual insurance premiums, end federal payments for states to expand Medicaid for the poor and disabled, and cut more than $700 billion in taxes over 10 years.
Act Blue, a clearinghouse political action committee that raises money for Democratic campaigns, has already helped raise more than $2 million to fuel challenges against House Republicans who backed the GOP plan.
Democrats also targeted Republican governors in Democratic-leaning states, including Maryland's Larry Hogan, who did not take a public position before the House vote.
"Where is their promise that no one is going to lose their insurance?" asked Connecticut Gov. Dan Malloy, chairman of the Democratic Governors Association.
"They have no intention to honor what they ran on," he declared. "It's the sort of things that cowards do, and the Republicans in Congress and in the statehouses are cowards. ... It is remarkable, and we will be reminding people of it."
In Ohio, Democrats targeted Rep. Jim Renacci, who voted for the bill, as he runs for governor in a contested Republican primary campaign. Outgoing Gov. John Kasich, a Republican, condemned the Republican measure as "woefully short."
Outside Washington, the Trump resistance mobilized quickly. The first of the grassroots protests were held in House Speaker Paul Ryan's Wisconsin district hours after Thursday's vote. Democratic activists were planning many more demonstrations for next week's congressional recess.
"There's already a lot more energy and engagement among Democratic voters, and this is going to put the enthusiasm gap on steroids for Democrats," said Democratic pollster Geoff Garin, who advises Priorities USA, a top liberal political organization.
Some Republicans maintain that the GOP had no choice.
"The House Republican majority was in far greater jeopardy had we not repealed Obamacare," said Republican strategist Mark Shields. If Republicans didn't deliver after years of promises to their conservative base, he said, they'd "get crushed" in 2018.