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Now that the Republican health-care bill has passed the House, there's a whole other set of obstacles it will face in the Senate. (Jenny Starrs/The Washington Post)

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.

But not so fast, say Republicans. One, we don't even know what the final version of this legislation will be. The Senate will probably change it drastically before it goes to President Trump's desk. (To avoid a Democratic filibuster, Republicans have to make sure each piece of the legislation directly deals with the budget. Also, there are parts of this House bill that are very conservative and could never pass the more moderate Senate.)

[Whats next for the Republican health-care bill]

Two, if Senate Republicans cobble together a less politically charged health-care bill, it could be Senate Democrats on the defensive. There are 10 Senate Democrats up for reelection in 2018 in states that Trump won. Are those Democrats really going to block a change to Obamacare, a law many of their constituents still want to see repealed?

It's a base third rail, said GOP strategist Josh Holmes. If you're a Democrat, you cannot even begin to entertain a discussion of repealing Obamacare, yet the vast majority of people in places like North Dakota and West Virginia and Missouri and Indiana are fundamentally on the other side of that.

Actually, Sen. Jon Tester (D-Mont.), who is up for reelection in a state Trump won by 18 points, is starting to have that conversation. In an interview Thursday with Fox News, he said he'd be open to repealing and replacing Obamacare: It needs to be improved. It hasn't been improved. We can either work to improve that, or repeal it and replace it with something better. I'm open to either one.

Other potentially vulnerable Senate Democrats don't seem to be feeling the same pressure yet. Its awful what theyre doing to the working man, Sen. Joe Manchin III (D-W. Va.), who's running for reelection in a state Trump won by more than 40 points, told my colleague David Weigel in April.

The House health-care bill is a disaster for Hoosier families, Sen. Joe Donnelly (D-Ind.), another vulnerable Democrat, said in a statement Thursday.

The fact that Trump appears to be behind this bill, full-stop We want to brag about this, a beaming president said in the Rose Garden on Thursday gives more comfort to Senate Republicans. Trump is still as popular in many of these red states as Obamacare is unpopular.

Bring it on, say Democrats. House Republicans just voted for a bill that potentially strips away coverage for people with preexisting conditions and could leave 24 million more people uninsured over the next decade 14 million over the next year alone. A number of those House Republicans could be Senate challengers to Democrats in 2018.

Hours after the House passed the bill, the Democratic Senatorial Campaign Committee launched a six-second, non-skippable YouTube ad in Nevada and Arizona, where potentially vulnerable GOP Sens. Dean Heller and Jeff Flake are up for reelection. In April, they relaunched 30-second digital ads in 12 battleground states imaging a dystopian GOP health-care landscape: A woman pawns her wedding ring and a man sells his car to pay for their sick child's health-care costs.

After Republicans in the House passed their health-care bill on May 4, the Democratic Senatorial Campaign Committee launched a digital ad about the personal toll of health-care costs. This is part of a targeted campaign against potential Senate Republican candidates. (Democratic Senatorial Campaign Committee)

The strategy is to make potential GOP Senate candidates like Reps. Todd Rokita and Luke Messer in Indiana, or Kevin Cramer in North Dakota, or Evan Jenkins in West Virginia Heller and Flake answerable to what Democrats are pretty sure will be a huge drop in coverage across the nation.

The reality of voters losing their health insurance is a much more immediate concern to red-and-purple state voters than whatever they may feel about Obamacare, said Jim Manley, a Democratic strategist: I'm licking my chops to try to message against these guys.

Sure, changing how people receive and pay for health care is always a risk, Republicans acknowledge. But they say they had to do something to make good on a seven-year campaign promise.

It's not clear to either side yet whether this moment is the Obamacare debate in reverse.

There are a tempting number of similarities to draw on from 2010, when Democrats passed Obamacare without a single Republican vote: A party is drastically changing people's health care before the first midterm of a new president. When Democrats did it, they got clobbered in the next midterm.

Republicans won six seats in the Senate and netted 63 House seats (and the majority) in the House. Democrats have yet to win the House back, and they lost the Senate in 2014 in part over voter resentment about Obamacare.

Democratic operatives in both the House and the Senate think this just might be Republicans' Obamacare moment.

History has shown that the first mover on health care faces the consequences, said Jim Kessler, a former top Senate Democratic aide now with the center-left think tank Third Way. I'd much rather be a Democrat in a red state defending Obamacare than a Republican in a purple state repealing it.

It depends on how peopleactually feel about Republicans' changes to their health care, Republicans say. And we have no idea how they'll feel, because, well, we have no idea what kind of health-care overhaul the Senate will pass, whether the House will agree to it, or whether Trump will sign.

If a year and a half from now, people feel like their health care is more affordable and accessible, that is a big win for the party in power, said Alex Conant, a GOP campaign strategist. If a year and a half from now, voters feel like health care is even more expensive, and there's even less stability in the marketplace, that will be advantageous for the opposition party.

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