Opinion writer


President Trump is now claiming he really, really wants to make a big deal with Democrats, striking a rhetorically conciliatory pose after previously suggesting that Democrats would come to him on their knees begging him to bail them out once Obamacare collapsed all around them. ABC News reports that Trump told senators at a White House reception Tuesday night that a deal is “going to happen,” because “we’ve all been promising — Democrat, Republican — we’ve all been promising that to the American people.”

Meanwhile, National Journal reports that the White House has privately begun reaching out to moderate Democrats to feel out whether any kind of deal is possible.

Even though everything Trump says is subject to change in literally the next breath, or tweet, it’s worth taking this seriously, if only because it could provide a means to answering a question that remains oddly unanswered: What does Trump actually want on health care?

Democrats can call Trump’s bluff here, by laying out what they want as part of any prospective deal. Nicholas Bagley, a law professor at the University of Michigan and an expert in health policy, argued to me this morning that there are compromises the parties could make on health care, if they wanted to.

For instance, Democrats could demand that Trump refrain from doing anything to further destabilize the individual markets, or even demand that he take steps to shore them up, so insurers don’t flee and leave millions of people with no way of getting coverage or accessing tax credits. This would include a commitment to keep paying “cost-sharing reductions” to insurance companies, which enable them to reduce out-of-pocket costs for lower-income enrollees (if those are cut off, insurers may bolt). Those are subject to ongoing litigation (Republicans previously argued they are illegal), and Democrats could ask Trump to prevail on congressional Republicans to codify them in statute to preserve them.

Democrats could also ask the administration not to pull back outreach designed to get people to enroll on the marketplaces. Or they could ask Republicans for a beefing up of subsidies for lower-income people on the exchanges, though that’s a tall order, since it means more spending.

In exchange, Bagley notes, Republicans might have their own asks. As part of a long-term compromise, they might ask Democrats to agree to allow states more flexibility when it comes to requiring insurers to provide “Essential Health Benefits,” or potentially change the Affordable Care Act’s tax scheme so it isn’t quite so progressive.

Such a deal would be very difficult for liberals to accept. But even if states had more flexibility in regulating insurers, this would function as a kind of bluff-calling. It is easy for Republicans to oppose “regulations” in the abstract, but GOP state legislators might have a tougher time scrapping those requirements, which the public might prove to want, even in red states. What’s more, in exchange for some deregulation, Democrats could demand that Republicans drop the push to weaken the Medicaid expansion by imposing block grants or per-capita caps, which would lead to a rollback of coverage over time, and instead commit to a baseline guarantee that everyone can get health coverage if they need it.

“The closest you might come to a deal might include as a backstop the obligation that everyone can get health insurance coverage, while states have the opportunity to say what counts as coverage in their states,” Bagley says.

Obviously, any such deal is extremely unlikely, since each side would recoil at the other’s asks. Democrats might argue that there’s no reason to deal, since Republicans may not have the votes to repeal the law. But Trump is nonetheless in a position to severely undermine the ACA right now — which could hurt millions of people — so Democrats have an interest in preventing that from happening. Beyond this, merely starting this conversation might have a salutary effect. We simply don’t know what Trump actually wants from health care — does he want the “insurance for everybody” that he promised, or does he simply want whatever Republicans can pass, so he can say he “won” by killing his hated predecessor’s signature achievement?

Now that Republicans can’t pass an ACA replacement, maybe there’s an opening to pin Trump down a bit on what he really does want. He may not have any policy goals at all in mind, of course, but during the campaign, he did seem to articulate a hazy commitment to a robust government role in covering poor and sick people. It’s not impossible that Trump harbors a few general principles, however murky.


* TRUMP HAS TURBO-CHARGED DEM FUNDRAISING: Politico crunches the numbers and finds that Democratic candidates and incumbents are bringing in big bucks, much of it from small donors enraged by Trump:

Jon Ossoff, the Democratic candidate for an open House seat in Georgia, raised nearly $2.1 million online last month for his April special election. … In February alone — and just online — Missouri Sen. Claire McCaskill, a top GOP target in 2018, brought in over $212,000 in donations of under $200. … Connecticut Sen. Chris Murphy … received nearly $650,000 online in February … a wide range of progressive groups are also reporting online fundraising spikes.

The question will be whether the anger and energy translate into big voter turnout in 2018, given the traditional midterm dropoff among core Democratic constituencies.

* REPUBLICANS WORRY ABOUT LOSING HOUSE: National Journal reports that the conditions are gathering for a Democratic House takeover, including energized Democrats; dismal Trump numbers; and the GOP base demoralized by the health-care mess. Former NRCC chair Tom Davis:

“The midterm elec­tions are all about who shows up. Demo­crats are already up­set and angry; you’re already see­ing this dy­nam­ic at the protests and town halls. Now the Re­pub­lic­an base be­comes dis­pir­ited after this. You might be able to hold the House with just your base, but this is bad.”

Additional factoid: “Of the 36 at-risk House Re­pub­lic­ans … 28 rep­res­ent urb­an or sub­urb­an dis­tricts where Trump isn’t par­tic­u­larly pop­u­lar.”

* GEORGIA SPECIAL ELECTION COULD INDICATE DEM ENERGY: Nate Cohn runs through the reasons Democrat Jon Ossoff could pull off a surprise win in the April 18 special election for a GOP-held seat in the Atlanta suburbs, and notes:

The enthusiasm that brought millions of Democrats to the streets and millions of dollars into Mr. Ossoff’s campaign account might just translate into an unlikely and possibly big turnout edge … a strong Democratic turnout in Georgia’s Sixth would certainly raise the possibility that the party can cure its enthusiasm gap in the midterms.

It’s worth watching, though as Cohn also notes, it is also perilous to over-read the broader political significance of special elections.

* MODERATE REPUBLICANS SHOULD FEAR REPEAL PUSH: With the GOP leadership signaling that they might try again to repeal Obamacare, Roll Call reports that moderate House Republicans have good reason to worry that this could make them more vulnerable:

With leadership signaling it’s sticking by its commitment to repeal and replace the 2010 health care law, they have every reason to want … a different approach — to save themselves and their party. … The moderate opponents of GOP leadership’s bill, many of whom are in districts Hillary Clinton won last fall and are already Democratic targets, were essentially standing against the bill alone.

Even as the failure to repeal the ACA could demoralize the GOP base in the 2018 elections, any efforts to restart the repeal effort could put moderates at greater risk. Sad!

* PRESSURE MOUNTS ON GOP LAWMAKERS OVER MEDICAID: The Kansas state legislature has voted in favor of expanding Medicaid, and The Post points out this could herald more pressure to expand Medicaid in holdout states, now that GOP repeal has flopped:

In Virginia, Gov. Terry Mc­Auliffe (D) on Monday pledged to revive efforts in his state’s Republican-led legislature to pass Medicaid expansion. Georgia’s Republican governor, Nathan Deal, also announced plans to change his state’s Medicaid program. Medicaid advocates in North Carolina see hope for renewed momentum as Gov. Roy Cooper (D) has sought to expand the program there through executive action.

Kansas Gov. Sam Brownback will probably veto his state’s expansion, citing the lie that the ACA is imploding, but the pressure will continue to mount on resistant GOP state lawmakers.

* HILLARY EDGES BACK INTO THE ARENA: Hillary Clinton gave a speech last night that included this broadside against Trump:

“These are bad policies that will hurt people and take our country in the wrong direction … Resist, insist, persist, enlist.”

This looks like a sign that she’ll be amplifying her public criticism of Trump and his agenda in the days ahead. Of course, this is a lot easier to do, now that Trump’s agenda is stalling and his approval is in the toilet.

* AND THE POLL FINDING OF THE DAY, ALTERNATE FACTS EDITION: A new CBS News poll finds that a whopping 74 percent of Republican respondents think it’s very or somewhat likely that Trump’s phones were wiretapped. Depressingly, the public is divided on this question, 47-50.

Maybe Trump’s “alternative facts” strategy is having some success, after all …