The GOP drive to destroy Obamacare took another hit Thursday morning, when conservative Sen. Tom Cotton tweeted that the House GOP repeal-and-replace bill is probably dead on arrival in the Senate. Cotton even called on his House colleagues to “start over.” The Arkansas Republican is an ally of Trump — who favors the GOP bill — so this is somewhat significant.

But fear not: If the GOP repeal drive does fail in Congress, Trump has a secret, backup plan to kill the Affordable Care Act. And it’s actually a pretty good plan, if you view it from the point of view of Trump and many Republicans.

In an Oval Office meeting featuring several leaders of conservative groups already lining up against the House Republican plan to repeal and replace Obamacare, President Donald Trump revealed his plan in the event the GOP effort fails: Allow Obamcare to fail and let Democrats take the blame, sources at the gathering told CNN.

If you think about it, this actually makes sense. If the law survives, Trump can spend the next couple of years claiming that it is collapsing all around us — or rather that it continues to collapse, since it is already collapsing as we speak. And Republican voters will of course believe that this is the case, since it is an unshakable truism for them that the law has already failed in spectacular fashion.

Meanwhile, conservatives in Congress will say the same thing. As one GOP aide put it to me this morning: “Many conservatives believe Obamacare already failed, so we’ll echo him.”

The beauty of this outcome is that it would keep intact an arrangement that has worked quite well for Republicans for years: They can continue to rail at the evils of the ACA, without having to deal with the fallout of it actually being repealed.

The story of the moment is that this cozy arrangement is getting disrupted rather violently. The challenges that attend fashioning an actual repeal-and-replace bill have ripped the lid off of a rift among Republicans that remained safely hidden out of sight while repeal was an impossibility.

House Republicans on March 6 released legislation that would substantially alter the Affordable Care Act. Here’s what you need to know about the plan. (Bastien Inzaurralde, Sarah Parnass, Jenny Starrs/The Washington Post)

On one side of this divide are conservatives (mostly in the House) who actually want the ACA repealed, because they are philosophically opposed to the spending and regulating necessary to expand coverage in the manner Obamacare has. On the other are Republicans (mostly senators and governors) who now have to say they want repeal — after all, they demanded this for years in the abstract — while also moving to limit the rollback of coverage that results, particularly in their own states. Thus it is that many of the senators and governors who have expressed skepticism about the House GOP plan come from states that have expanded Medicaid.

The current House GOP plan tries to give each of these camps a way to claim they are getting their way, but it ends up giving neither one enough. It continues to spend and regulate, so it’s a nonstarter for conservatives, especially House Republicans in very safe districts who will be insulated from the political fallout of millions losing coverage. But that huge looming coverage loss means Republicans who represent whole states have to worry about them taking a huge hit. The difficulty in bridging this gap is illustrated by this nugget of CNN reporting:

Sources at the meeting said White House aides showed some openness to one aspect of the House GOP plan that has become an irritant to tea party aligned groups: the provision that pushes back an overhaul of the expansion Obamacare Medicaid funding until 2020.
The conservative groups at the meeting asked that the date be moved up to January 1, 2018. White House aides said they were “open to discussing” it, sources said.

In other words, the White House might be willing to start phasing out the Medicaid expansion earlier to make conservatives happy. But this would mean that the fallout hits right amid the 2018 midterm elections, something that could not only impact the congressional and Senate races, but also the hugely consequential 2018 gubernatorial contests, in which repeal of the Medicaid expansion could create major complications.

Meanwhile, it’s not crazy to imagine that conservatives might prefer for the current repeal effort to fail, at least in its current form. As Jonathan Chait notes, if it goes through, the GOP will have given its philosophical stamp of approval to government spending and regulating, albeit in a more limited form. If the public responds with outrage at the lost coverage, there could be a push to restore it — and this battle would unfold on philosophical turf that the GOP has already ceded. Indeed, this is likely a key reason conservatives want the current bill to fail. And needless to say, if it does fail, and the ACA lives on, conservatives can continue to say it’s a horrific failure — no matter what actually happens — thus proving them right about the folly of government efforts to expand coverage.

Now, obviously, many Republicans — and Trump — almost certainly prefer for the current bill to pass. Trump hates losing, and Republicans don’t want their voters to see them fail to deliver the glorious moment of liberation they have anticipated for years. But if they do fail to deliver, Trump’s backup plan has its virtues, too.


* GOP HEALTH BILL MOVES FORWARD: The Hill reports that early Thursday morning, the House Ways and Means Committee approved the GOP repeal-and-replace bill, but without some crucial information about it:

The committee called a markup without a CBO score, meaning lawmakers voted without an analysis of how much the bill will cost or how many people would lose coverage.

But seriously, why would Republican lawmakers need to know about such irrelevancies? Anyone who is surprised by this hasn’t been paying attention to American politics for the past eight years.

* HOSPITALS HAMMER GOP PLAN: An array of hospital groups have now signed on to a letter blasting the GOP repeal-and-replace plan:

It is likely to result in a substantial reduction in the number of Americans able to buy affordable health insurance … we are deeply concerned that the proposed Medicaid program restructuring will result in both the loss of coverage for current enrollees as well as cuts to a program that provide health services for our most vulnerable populations, including children, the elderly and disabled.

One question is whether any GOP lawmakers will be moved by opposition from hospitals in their states and districts.

* CONSERVATIVES RAGE AT TRUMP WHILE HE ‘LISTENS’: The New York Times reports one other nugget from his meeting with conservative leaders:

He was especially troubled, one participant said, by the comparisons of the plan to “Obamacare lite,” which he said was inaccurate and harmful to their shared cause of gutting the current law.
One senior White House official described the meeting as “tough.” Referring to the president, the official said: “He listened. They vented.”

Obamacare lite! That must really get under Trump’s skin. The Times also notes that he’ll hold stadium-style rallies in the states of conservative lawmakers who are holding out. We’ll see how that works out.

* RAND PAUL CALLS FOR MULTIPLE REPEAL VOTES: Sen. Rand Paul (R-Ky.), who opposes the current House GOP repeal-and-replace bill, tells CBS News:

“A year ago we voted on a clean repeal and that’s what we should vote on again … let’s vote on a variety of different choices for replacement and see which one gets enough votes to pass.”

One interesting possibility is that such a move would allow conservatives to vote for repeal — clean repeal — which would give them room to oppose the GOP repeal-and-replace bill, potentially sinking it.

We shouldn’t blithely move on to other matters until we deal with the institutional carnage inflicted upon us by President Trump … If our republic had a responsible Congress, its leaders would accept their duty to demand that a president who shakes his country and the world with such an outlandish allegation either put up proof or apologize … Instead, Republican leaders think it is time for business as usual, which in their case means figuring out how to deprive low-income people of health insurance while cutting taxes on the rich and increasing the deficit.

It’s another way in which congressional Republicans are enabling Trump’s erosion of our democracy on multiple fronts.

Multiple government agencies are in a state of staffing gridlock, with Cabinet secretaries having their chosen employees routinely returned by the White House’s Office of Personnel Management … The failure to fill lower-level staff directly impacts the ability of government to function. Career people are working away, but senior political appointees lack their own staff. They’re less effective — and operating in a climate of distrust — until they’ve got their team around them.

But Trump says his administration is running like a “fine-tuned machine,” so anything contrary to that must be Fake News.

* AND TRUMP MIGHT HAVE LEARNED FROM OBAMA: NBC’s First Read crew points out that Obama actually did try to reach out to the opposition during the 2009-2010 health-care effort, something Trump has failed to do:

Obamacare didn’t get a single vote from a Republican lawmaker. But it wasn’t for a lack of trying. The Obama White House actively courted Sens. Susan Collins and Olympia Snowe (R-ME), as well as Sen. Chuck Grassley (R-IA). Indeed, Snowe voted for the Senate Obamacare proposal in committee in October 2009 — although she backed away in the votes for final passage. This time around? The Trump White House and congressional GOP leaders haven’t made at least the appearance of this kind of effort.

You aren’t supposed to say that — after all, both sides always must be held equally culpable for breakdowns in bipartisanship — but it happens to be true.