His failure to convert the core campaign promise of repealing and replacing Obamacare - even with a GOP monopoly on power in Washington - has left the White House reeling.
Trump and his advisers must now regroup and try to figure out how to avoid another legislative debacle on their next big issue, tax reform. They will do so knowing that a second failure could throttle his presidency.
Once, Trump's aides viewed health care reform, presumably an easy early win, as a way to deliver momentum to his presidency and to build toward more sweeping change picked from his ambitious agenda.
But the effort's ignominious defeat Friday has severely weakened the President, electrified Democrats and left Trump's declarations that he is the ultimate dealmaker who can change Washington looking increasingly hollow.
Trump surprised some of those close to him with his reaction to Friday's health care collapse. He did not vent or rage. Instead in the Oval Office afterward Trump was "sullen and quiet" as he contemplated his first blow, dealt by the Washington swamp he had vowed to drain, one insider source said.
