Donald Trump holds up a fist after speaking during a campaign event in King of Prussia, Pa., on Nov. 1, when he said he would quickly repeal the Affordable Care Act. (Jabin Botsford/The Washington Post)

One week before the election, Donald Trump traveled to the Philadelphia suburbs to deliver a health-care policy speech that was light on details and heavy on grand promises and dramatic warnings.

In a hotel ballroom in King of Prussia, his running mate, Mike Pence, introduced him as a dealmaker, fighter and winner “who never quits, who never backs down.” Trump promised to “convene a special session” of Congress as soon as he was sworn in — an idea that confounded many, as Congress was already set to be in session — so that lawmakers could “immediately repeal and replace Obamacare.” All of this would happen “very, very quickly,” he said.

“If we don’t repeal and replace Obamacare, we will destroy American health care forever,” Trump said. “It’s one of the single most important reasons why we must win on November 8th. We must win.”

The invite-only crowd burst into cheers and chanted: “Trump! Trump! Trump!”

Since Trump became president, his promise to repeal and replace the Affordable Care Act is nowhere close to being fulfilled, despite his repeated, confident assertions on the campaign trail that it could be done in just a day. The failure of health-care legislation in the Senate this week shows Trump still has not learned how to navigate Congress — and how much he is struggling to be the dealmaker, fighter and winner he portrayed himself to be to voters.

(Jenny Starrs/The Washington Post)

One of the Republicans cheering Trump’s speech in November was Renee Amoore, the deputy chairwoman of the Pennsylvania GOP who runs a health-care company and volunteered on Trump’s transition team. Even though she knew that Washington did not work the way Trump was describing, she was confident he and Republicans could quickly repeal the Affordable Care Act and replace it — after all, that’s what they had promised to do.

When Amoore learned the legislation collapsed in the Senate this week, she thought to herself, “Oh, Lord.” She’s frustrated that the White House has become distracted by Russia-related charges and that Trump was not actively fighting for the legislation and clearly communicating with lawmakers.

“This has got to stop,” said Amoore, 64, of Trump’s approach to legislation. “So what do you do? You start banging on doors, you start calling people up. . . . Senators, they want to be called, they want to meet with the president.”

More than eight months ago, Trump was gaining momentum in the final days of the campaign, and his advisers organized a health-care policy speech for Nov. 1, the first day of open enrollment on the marketplaces made possible by the Affordable Care Act. They chose a hotel near Valley Forge, where George Washington and his troops spent a miserable winter during the Revolutionary War, and invited several Republican members of Congress to warm up the crowd with grave warnings about Obamacare.

Sen. John Barrasso (R-Wyo.), an orthopedic surgeon, declared: “Republicans are here today with solutions and relief.” Rep. Tom Price, an orthopedic surgeon from Georgia who is now Trump’s secretary of health and human services, claimed Republicans have “been working on that solution for years, literally.” And Rep. Michael C. Burgess, a gynecologist from Texas, said elected leaders are “champing at the bit to develop the policy that will then go down to the other end of Pennsylvania Avenue and be signed into law by President Trump that will end Obamacare once and for all.”

Rep. Scott DesJarlais (R-Tenn.), a general practitioner, warned that the United States is “at a crossroads in health care.” In an interview on Tuesday, DesJarlais said he had hoped that Republicans would have passed health care and tax restructuring by now. Although he defended the president as being “pretty darn engaged,” he acknowledged there has been a learning curve.

“This is something the president has never done before,” DesJarlais said. “He’s learning that Washington is different than running Trump enterprises.”

(The Washington Post)

In the crowd that day in November was Raymond “Ray” Ballone, 62, who was invited by a local politician. Ballone once worked for a steel company but was laid off when its operations moved to Japan. He then worked in construction and started his own company, only to find it increasingly expensive to get health insurance. As he neared retirement age, he searched for a job with benefits and started driving a school bus.

He said he never believed Trump would actually repeal and replace Obamacare within a couple of days, but he did believe that Republicans would eventually get a plan passed — and he is still hopeful it will happen.

“When they’re running for office, they say a lot of things, and they may believe it,” said Ballone, who lives in Plymouth Meeting, Pa. “But when you get into the mix, you can’t do it alone. . . . He’ll get to those promises. It will take time, but he will get to them. He’s not a king. He can’t just do it.”

After Trump’s speech in November, he and his entourage made a quick stop at a local Wawa convenience store — and ran into Tom Kohler, a local Democratic Party leader who works for a Democratic state lawmaker. Kohler was buying a hoagie on his lunch break and ended up in a photo with the Republican candidate looking less than impressed.

“I still get introduced to friends of friends as the Wawa guy,” he said Tuesday.

Kohler said that those living in his area — which heavily voted for Hillary Clinton — have long been worried about what could happen to their health care under Trump. He said the fact that the Republican-dominated Congress could not pass a health-care bill is a reminder that while Trump won the electoral vote, his views are not shared by many Americans, something that lawmakers seem to be keeping in mind as the 2018 midterm elections approach. Trump won Pennsylvania by a thin margin, and four of the 20 House Republicans who voted against the health-care bill were from that state.

Kohler said maybe now Trump supporters will realize that his promises are empty.

“We’re six months in, where is it?” Kohler said of the better health-care system Trump promised. “The answer is, there is no plan.”

Mike DeBonis contributed to this report.