Where are political moderates when health care needs them?

Most people, when treading water, would be less than thrilled to be handed a concrete life preserver.

Yet President Donald Trump sounded as tickled as a schoolboy with the hastily drawn American Health Care Act that House Republicans passed to repeal and replace President Barack Obama's Affordable Care Act, also known as Obamacare.

"How am I doing? Am I doing OK?" he said in a Rose Garden celebration with House Republicans. "I'm president. Hey, I'm president. Can you believe it?"

Not yet. I still have a hard time believing it. I still wake up in the morning with a disbelieving, "President who?"

So I found it oddly reassuring that, after more than 100 days in office, he sounded as though he finds his election as hard to believe as I still do. Maybe he is not as politically clueless as he sometimes sounds.

Still, the Trump-backed AHCA is a political turkey badly out of step with the times and public sentiments. The Obamacare that it is supposed to replace actually has gained in popularity as more people begin to learn what they'll lose without it. For the first time in the Gallup Poll, 55 percent of Americans approved of the ACA, its highest numbers yet.

Yet House Republicans passed a bill that does far more to repeal than to replace. It's not as much of a health care bill as a tax bill, critics have pointed out, using hundreds of billions of dollars in cuts to Medicaid, for example, to offset hundreds of billions in tax cuts for the wealthy.

House Speaker Paul Ryan rushed the bill through the House before the Congressional Budget Office would tell lawmakers what it would cost. But the CBO famously estimated that an earlier draft would lead to 24 million people losing their coverage over the next decade.

Threats like that turn up pressure on Republican lawmakers who face challenges in swing districts. Following Napoleon's dictum, the Dems don't want to interrupt opponents who are busily destroying themselves.

Indeed, some Dems couldn't restrain themselves from trolling Republicans on the House floor by singing the old Steam hit "Na Na Hey Hey Kiss Him Goodbye" to their Grand Old Party colleagues after the vote. "They have this vote tattooed on them," declared House Democratic leader Nancy Pelosi after the bill passed the House. "This is a scar they carry."

Yet Democrats can't afford to be too cocky. It is they who have lost not only the House, Senate and White House but also a majority of state legislatures and governors' offices -- all in the Obama years.

A look back reveals that Democrats suffered a problem that Republicans could face today, a buildup of numbers in some districts -- particularly those that favored Obama -- and, at the same time, a massive erosion in others, particularly those that favored Trump.

Thanks to the Electoral College, as Dems learned the hard way in 2000 and last year, Republican votes spread out across more important swing states than Democratic votes. The result has posed a challenge to Democrats to return to the working-class and lower-middle-class voters who reliably delivered them congressional majorities from the days of the Franklin D. Roosevelt coalition until the rise of Ronald Reagan conservatism after the 1970s.

If anyone understands those swing voters that Democrats need to reach, it is West Virginia's Sen. Joe Manchin, a Democratic ACA supporter who nevertheless has been just conservative enough to keep his seat in his red state. His secret, in my view, is to show constituents in his highly impoverished state that, regardless of his party affiliation, he understands them and he's on their side.

Memorably, Manchin says he cautioned President Trump against underestimating Obamcare's popularity. It has brought badly needed coverage such as opiate addiction treatment and mental health services to many for the first time.

Some 172,000 West Virginians have insurance for the first time, Manchin says he told Trump. "They don't know how they got it," he said, but "they're going to know who took it away from them."

There's general agreement in both parties that Obamacare needs repairs. But we need more moderates like Manchin who are willing and able to work across party lines to make those repair on behalf of their voters, not against them.

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(E-mail Clarence Page at cpage@chicagotribune.com.)