Health care bills moves votes. They cost seats. They start waves. The Democrats’ two runs at health care reform ended with Republican gains of 54 seats in 1994 and 63 seats in 2010. In the latter case, Massachusetts was the canary in the coal mine, as health care helped propel Scott Brown past Martha Coakley and into Ted Kennedy’s (errr, the people’s) seat in the Senate. That was the beginning of the red tide which has rolled across the country in the years since, with Republican electoral wins piling up at all levels of government. Certainly, other factors were at play, but health care played a major role.

The polling on the GOP’s American Health Care Act suggests that Republicans run similar risks in 2018 over their repeal and replacement of the Affordable Care Act (Obamacare). The original plan — repeal an unpopular bill and replace it “with something terrific,” to be announced later — seemed like a winner for the years Republicans were voting over and over again for symbolic repeal measures. More voters opposed Obamacare than supported it from 2009 to late 2016, so opposition seemed safe.

But a curious thing started to happen right around Election Day 2016: Obamacare started getting more popular, even as Republicans finally came within reach of ending it. It nowaverages 48 percent support in recent polls, with 43 percent opposed. By contrast, the GOP replacement is averaging a -16 percent net approval, and it may be heading even lower. The latest poll, from Quinnipiac out yesterday, found that only 17 percent Americans support the new legislation. That is a lower support level than any of the 498 national polls taken on Obamacare since 2009.

President Trump’s efforts on behalf of the bill do not appear to be helping. Just 29 percent approve of his handling of health care, according to the Quinnipiac poll; 37 percent approve of his job performance overall, compared to around half for Obama on the eve of the Affordable Care Act. Crucially, Quinnipiac found that Trump is now losing the support of his base: white voters without a college degrees. Trump net favorability with these voters dropped a remarkable 19 points from their last poll,  and only 22 percent of non-college whites approve of the GOP health care bill.

The friction that could burn Republicans is between appeasing independent voters to win reelection versus winning the vote of the House’s most conservative members to pass the bill. Support for the bill among independents is a paltry 14 percent in the Quinnipiac poll. Moderate Republicans in competitive districts need these independents to win reelection, and moving the bill further right could make these numbers even worse. But a big chunk of the opposition in the House is from the House Freedom Caucus, a group of the most conservative members of Congress who want to the bill moved exactly in that direction.

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