WASHINGTON - In the roiling debate over the plan to replace the Affordable Care Act, there's a lot more at stake for President Trump than whether the bill can be saved: Its fate could also determine how much else he can get done on Capitol Hill in the early stages of his presidency.
With the bill facing strong resistance on multiple fronts, Trump's effort to shepherd it through Congress is shaping up as a pivotal test of an unorthodox president's ability to wield influence in Washington, a growing number of Republicans say.
A win on an issue as fractious as health care could serve as a rallying point for even tougher fights ahead, including some Trump agenda items that wouldn't otherwise be GOP priorities and others that would likely require Democratic support.
But falling short on a marquee campaign promise - when both chambers are controlled by the president's party - would almost certainly sap momentum for Trump's agenda. Moreover, Republicans are counting on cuts from former President Barack Obama's health-care law to make the budget math work on other Trump priorities, particularly major tax reductions.
"It's difficult to see the kind of aggressive agenda that they've outlined for the rest of this year without some sort of repeal-and-replace success," said Michael Steel, a former senior aide to former House Speaker John A. Boehner (R., Ohio), referring to the House bill that seeks to scale back the health-care law, often called Obamacare.
The coming weeks, Steel said, "will show whether the Trump administration can use the tools of the White House to move legislation forward."
As a candidate for president, Trump promised that he would work with Congress to pass legislation that would dramatically cut taxes, spur $1 trillion in infrastructure investments, significantly expand school choice and make it easier to afford child care. And he promised he would get started on all that - and six other pieces of legislation - in his first 100 days, according to a "Contract with the American Voter" released shortly before Election Day.
Now past the 50-day mark, only one of those bills - the House GOP health-care plan - has been introduced. And its path has grown more treacherous by the day, with mounting concerns about the millions of Americans projected to lose coverage, including many who supported Trump in last year's election.
During his daily news briefing Tuesday, White House press secretary Sean Spicer said Trump remained open to improving the bill but emphasized the urgency of moving forward on a long-standing Republican promise.
"This is the only vehicle that seeks to achieve what people on our side of the aisle have been talking about since 2010," Spicer said. "This is it. If we don't get this through, the goal of repealing Obamacare and instituting a system that will be patient-centered will be unbelievably difficult."
Trump's voter contract, released in late October, included a slew of promised executive actions as well as 10 specific pieces of legislation that he said he would introduce and "fight for" in his first 100 days.
White House aides point to progress on several executive actions, including Trump's second attempt at a travel ban targeting "terror-prone regions," as the document describes them.
But the only legislative initiative that can be checked off as introduced is the health-care plan. Even that bill would not do all that Trump advertised, which included reforms aimed at speeding the approval of lifesaving drugs and allowing the sale of insurance across state lines.
Other promised 100-day bills included a sweeping crackdown on immigration, including a southern border wall paid for by Mexico; a new system of tariffs to discourage companies from relocating abroad; and reforms aimed at reducing "the corrupting influence of special interests on our politics."
No such measures have been introduced.