Opinion writer

Whatever you think of the American Health Care Act on the merits, political watchers across the spectrum see a significant downside for Republicans who voted for the AHCA. Activists and groups on the left, like the Daily Kos, figure:

Of the 23 members who hold districts that voted for Hillary Clinton in 2016, 14 Republicans voted for the bill, as did another 10 of those whose seats Trump won with less than 50 percent (excluding districts in Utah, where conservative independent Evan McMullin drew substantially from Republicans). Democrats need to gain exactly 24 Republican-held seats while defending all 194 of their own to capture control of the House in 2018, and these 24 Trumpcare supporters will likely be prime targets.

The nonpartisan Cook Political Report shows six Republicans, including the Georgia 6th District seat, in the “toss up” category and 18 in the “lean Republican” column. In the “likely Republican” column are 19 more names, including 14 who voted for the bill. Add in the likely pickup for the Democrats of the seat held by Rep. Ileana Ros-Lehtinen (R-Fla.) — who is retiring from a district Hillary Clinton won by nearly 20 points — and you had 44 of the best potential Democratic pickups.

In that batch of 44 seats, only Ros-Lehtinen, two of the tossups, three in the lean-GOP group and four in the likely-GOP group voted against the bill. In short, a surprisingly few number of Republicans in at-risk seats (10) chose to save themselves with a “no” vote on the AHCA. With 24 seats needed for the Democrats to take back the House (23 if Jon Ossoff wins in Georgia) you see a very plausible path for the Democrats to take back the majority. Moreover, even among the 10 who voted “no,” Democrats will likely win Ros-Lehtinen’s seat and have a shot at the other nine.

How did the map get so treacherous? With the health-care vote:

Not only did dozens of Republicans in marginal districts just hitch their names to an unpopular piece of legislation, Democrats just received another valuable candidate recruitment tool. In fact, Democrats aren’t so much recruiting candidates as they are overwhelmed by a deluge of eager newcomers, including doctors and veterans in traditionally red seats who have no political record for the GOP to attack — almost a mirror image of 2010. …

In light of the vote, we are shifting our ratings in 20 districts, all reflecting enhanced opportunities for Democrats. The major caveat is that 18 months is an eternity in politics and that as always, we will continue to adjust our outlook as events unfold and the landscape develops.

The health-care vote is already taking its toll in other ways, as the Atlantic pointed out:

In its pitch for donations, the liberal website Daily Kos argues that a surge in donations “would both terrify Republicans and boost Democratic efforts to recruit good candidates … [and] help us defeat these Republicans next year.” The appeal directs readers to an ActBlue page raising money that will be earmarked for future Democratic challengers in 24 Republican-controlled districts where Trump won less than 50 percent of the vote in November and whose lawmakers voted in support of the GOP health-care bill. …

In light of the vote, we are shifting our ratings in 20 districts, all reflecting enhanced opportunities for Democrats. The major caveat is that 18 months is an eternity in politics and that as always, we will continue to adjust our outlook as events unfold and the landscape develops.

A separate ActBlue page for Democratic challengers to any House Republican who voted to support the bill had raised $405,783 by 10:27 a.m. Eastern on Friday. And Hillary Clinton took to Twitter to promote what appeared to be a different ActBlue page to fund challengers to Republicans who voted for the bill in swing districts.

Keep an eye out for other shifts in the political landscape, in which Democrats already have an enthusiasm advantage. We expect to see more demonstrations back in House districts, including town hall meetings and improved recruitment. Conversely, Republicans may suffer a difficult recruiting year and suffer more retirements.

That’s just on the House side. On the Senate side, The Post reports: “If Senate Democrats needed a miracle not to lose a ton of seats in the 2018 midterm elections, they’re pretty sure House Republicans just gave them one: Passing a bill that could kick tens of millions of people off their health insurance, then cheering about it behind a historically unpopular president.” Really, who is going to punish a red state Democratic senator who opposes a bill that would kick state residents off Medicaid and raise premiums for older, rural Americans?

The House bill may also create trouble for vulnerable Republicans such as Sens. Jeff Flake (Ariz.) and Dean Heller (Nev.). Also consider if red state Republicans previously seen as safe now find themselves playing defense. Freshman Sen. Deb Fischer (R-Neb.) has few accomplishments to her name, already has faced angry protests and has a mediocre approval rating. The bill would hit her state hard:

Lower-income individuals in Nebraska could see an $8,100 increase in their costs by 2020, and older residents could pay an additional $13,500, according to the analysis by the left-leaning Center for American Progress. Only five states would see larger increases — Alaska, North Carolina, Oklahoma, Arizona and Wyoming. …

Advocates are also concerned about proposed per-capita caps on the Medicaid program, touted as a way to reduce the federal government’s costs and give states more flexibility. The caps wouldn’t account for changes in the cost per enrollee beyond a predetermined growth limit, according to the nonpartisan Kaiser Family Foundation.

At-risk GOP senators could also face challenges from Republicans who claim incumbents have been too deferential to the White House and not concerned enough about the people back home.

In sum, the AHCA poses a host of challenges for GOP lawmakers. Unless the Senate is able to come up with a popular alternative to the AHCA and get the House to agree, every GOP lawmaker is going to be saddled with the passage of a bill that no one wants to defend and would do considerable harm to the most vulnerable Americans.