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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Editor’s Corner

April 22: Zombie Trumpcare Refuses To Die, But Looks Doomed

What’s that gurgling, snarling sound in the distance? Must be Zombie Trumpcare, which as I explained at New York, refuses to die.

Despite near-universal predictions of doom — either now or later, on the House floor or in the Senate — the Trump administration is pushing House Republicans hard to schedule a vote next week on the latest version of Trumpcare, a.k.a. the American Health Care Act. The president’s claim that the the plan had “gotten really, really good … and a lot of people are liking it a lot,” appears to be pure happy talk. They don’t have the votes now to move the legislation forward, and may never have the votes to get this unfortunate legislation to Trump’s desk.

The much-bruited MacArthur Amendment to the earlier bill, with its provision for state waivers to sidestep comprehensive insurance-plan requirements and protections for people with preexisting conditions, may or may not attract some additional House Freedom Caucus votes. But it is very, very unlikely to sway those among MacArthur’s fellow moderates who refused to vote for the original bill. Yes, it would allow blue states to keep something like the original Obamacare individual-health-insurance markets in place, assuming insurers were willing to go along. But it keeps in place AHCA’s quick phaseout of the Affordable Care Act’s Medicaid expansion, hammering those same states.

Prospects in the Senate, where Republican moderates have much more leverage due to the GOP’s narrow two-vote majority, are much worse. On top of the substantive health care policy concerns House moderates have articulated (particularly over Medicaid), there are now three GOP senators who are not necessarily onboard for the defunding of Planned Parenthood that is part of the package. And there remain real problems with the Senate rules, since the state waiver provisions that are central to the MacArthur Amendment could easily be ruled non-germane to the budget process by the Senate parliamentarian, exposing the whole bill to a Senate filibuster.

So why the rush toward an apparent abyss? From the White House point of view, it’s apparently all about Trump’s panic over not having big accomplishments to boast of when the 100-day mark of his presidency arrives, on April 29. That factor is also reportedly driving a sudden hard line in the White House position in the appropriations negotiations aimed at avoiding a government shutdown on April 29. Since a renewed furor over health care could not possibly help the atmosphere surrounding the delicate appropriations talks, Trump is in danger of a dual disaster next week.

Perhaps the best thing about racing ahead is that it might not allow the Congressional Budget Office the time to score this new version of AHCA, a process that would undoubtedly produce a terrible number in terms of the impact on health-care coverage.

You might expect Paul Ryan to tell Trump the votes aren’t there for Zombie Trumpcare, and to ask him to call off the dogs. But Ryan is undoubtedly under pressure from some members who would prefer to get the monkey off their backs and blame the Senate or Democrats for the failure to enact health-care legislation, and others who figure a second failed vote in the House would convince everyone to give up and move on to the more congenial territory of tax legislation.

It’s a horror-show for Republicans, all right.


April 21: Trump Could Yet Provoke a Government Shutdown

In what was a relatively peaceful Easter Recess for Congress, Donald Trump’s fatal pride is again causing trouble, as I explained at New York:

While everyone enjoys (and tries to exploit) the drama of an impending government shutdown, and the events of 2013 showed shutdowns can indeed happen, the deadline itself is disposable, since it is all too easy for negotiators to agree to short-term extensions of existing appropriations while talks continue. A one- or two-week extension remains the most likely scenario for next week, given the number of issues that must be resolved and the short time available after Congress returns from its Easter recess.

But there is an additional dynamic that could upset these expectations and create a higher risk of a shutdown: Donald Trump’s ego.

Like a howling feral dog on the edge of a peaceful town, Trump’s potential for havoc has haunted any and all sensitive congressional negotiations this year. CNN noted it as the “X factor” in the funding talks:

“So far the President has not issued any major controversial ultimatums – insisting on money for certain programs or barring it from others. If that changes, it could blow up the bipartisan talks.”

The reason that might happen is simple: April 29 marks the 100-day mark of the Trump presidency, and the image-conscious POTUS rather obviously hasn’t been on a winning streak.

Sure enough, Politico suggests today that the desire to show some results for the first 100 days is driving the White House toward a “harder line” in appropriations talks.

While the funding deadline can be pushed off temporarily, the 100-day milestone and the negative media assessments of the Trump presidency’s beginnings that are sure to dominate the airwaves can’t just be postponed. Thus the president’s underlings are under pressure to get some highly visible concessions in a hurry:

“The White House, under internal pressure to show legislative achievements ahead of the 100-day mark, is gearing up for a government shutdown fight to secure money for a border wall, more immigration enforcement officers and a bigger military, according to White House and congressional sources familiar with the plan.

“It is a risky gambit. With almost uniform Democratic opposition to nearly all of the Trump administration’s spending proposals, the fight could lead to a government shutdown next Friday — the day government spending expires, and right before the 100th day of Donald Trump’s presidency.

“People familiar with the negotiations say Mick Mulvaney, the budget director, and Marc Short, the White House legislative affairs director, are pushing congressional appropriators to include “billions” for their agenda in private conversations. The White House, one person familiar with the conversations said, has pushed for $3 billion for the border wall, and discussions have been ongoing.
Border-wall funding is one of several “poison pills” congressional Democrats have signaled might justify a Senate filibuster, gridlock, and a government shutdown. Another that involves a positive demand Democrats are making also touches on Trump’s ego: an appropriation for those Obamacare “cost sharing reduction” subsidies for insurers that the president has threatened to withhold unless Democrats help Republicans enact Obamacare repeal-and-replace legislation.”

Given the amount of time Trump spends claiming that undocumented immigrants are running wild in our cities and producing a hellish crime wave, you also have to figure budget director Mick Mulvaney’s recent demand that the funding bill include a cutoff of grants to “sanctuary cities” — still more shutdown bait — may have had its origins in the Oval Office.

All in all, if negotiators reach a tentative deal next week — or more likely, decide to kick the can down the road for a week or two — they will probably be checking their phones nervously for Twitter explosions from the man just down Pennsylvania Avenue. The president is certainly capable of pretending, as he’s already done, that his first 100 days were one long triumphal march toward unprecedented accomplishments. But if he decides he needs more trophies because his evil media enemies don’t see it, look out!


April 15: Paul LePage’s Threat to the Senate

In those wonderful days before Donald Trump ran for president, the most ridiculously entertaining Republican pol in the country was often Maine governor Paul LePage. He was back in the news this week with a frightening threat, as I discussed at New York.

Per the Boston Globe:

“Maine’s Republican governor says he’s strongly considering running for the U.S. Senate, but also feels he ‘wouldn’t make a very good legislator.’’’

“Gov. Paul LePage made the comments on a radio appearance on WGAN-AM on Thursday morning. The two-term governor is termed out of his current job in 2018 and he has been the source of speculation about his next move.”

Most of said speculation has revolved around a 2018 LePage challenge to Senator Angus King, an independent who caucuses with Democrats. He’s considering it, even though he doubts he would be good at the job and is concerned committee meetings “would be boring.”

Since he’s not that jazzed about the gig, perhaps LePage should make a Senate run conditional on someone talking Eliot Cutler into running as well — Cutler’s two independent candidacies for governor aided LePage’s election in 2010 and reelection in 2014 by pluralities.

There is possibly a different, easier route for LePage to get from Augusta to Washington: Senator Susan Collins has been openly talking about returning to Maine next year and running to succeed LePage. If she won, under current state law LePage would get to appoint someone to finish the last two years of Collins’s Senate term. He might find the most qualified candidate to be the belligerent man staring back at him from the mirror.

Yikes.


April 14: Trump’s Obamacare Squeeze Play on Democrats Backfires Spectacularly

Donald Trump probably thought he was pulling a trick out of The Art of the Deal when he tried to pressure Democrats into helping him salvage his healthcare disaster. But he tricked himself, as I explained at New York:

A heavy-handed effort by the president to take hostage insurer subsidies critical to the proper functioning of Obamacare — with the demand that Democrats cooperate to salvage Trump’s own failed health-care initiative — seems to be backfiring loudly. Soon after Trump made it clear (first via a statement from the Department of Health and Human Services, and then in his own words, in an interview with The Wall Street Journal) that he was indeed threatening to stop payment of the so-called Cost-Sharing Reduction subsidies (amounting to $7 billion in 2017 and an estimated $10 billion in 2018), congressional Democrats quickly struck back, reports The Hill:

“Congressional Democrats are demanding that key Obamacare payments be included in the next spending bill, raising the possibility of a government shutdown if they are not.”

The “spending bill” in question is the omnibus appropriations measure needed to keep the lights on in the federal government beyond April 28, the expiration date of the funding bill enacted last December. It has been the subject of extended negotiations involving the White House and both parties in Congress, aimed at removing “poison pills” that might produce a deadlock, a Senate Democratic filibuster, and a government shutdown.

Providing an appropriation for CSR payments would permanently take this particular weapon out of Trump’s hands — no matter how an underlying lawsuit, over the constitutionality of the Obama administration making the payments without such an appropriation, turns out….

Far from forcing Democrats to the table to help him pass the Obamacare repeal-and-replace legislation he cannot get with Republican votes alone, he has emboldened them to fight back. Given significant Republican support (even among House Freedom Caucus members) for keeping the CSR payments flowing to avoid an individual-insurance-market meltdown, Trump may have gone into battle with his own flanks exposed. And he has now managed to add a new complication to the already-sensitive discussions aimed at avoiding a government shutdown, for which he would inevitably bear the major responsibility.

He will likely have to back down pretty quickly. Besides the low odds of success — and the terrible optics of risking health coverage for millions of Americans because he can’t get his own party in line — there’s yet another problem: If Trump goes to the mats on this issue, he’ll have to answer to all the other powerful interests who are deferring their own demands to keep the federal government open. Is this complicated gambit on health care really more important to Trump than defunding Planned Parenthood or getting money for a border wall? That’s one of the problems with hostage-taking: All your friends will want their demands included on the ransom note.


April 7: California Democrats Show How To Get An Infrastructure Bill Passed

You may have missed this news from California late this week, so I wrote it up at New York:

Even as Donald Trump’s proposed infrastructure investment proposal remains, as Matt Yglesias cleverly calls it, mostly “vaporware,” California Democrats led by Governor Jerry Brown just met a tight self-imposed deadline by getting their own $52 billion plan for fixing roads, highways, bridges, and some transit facilities over a two-thirds threshold for revenue increases. And in so doing they may have provided a few lessons for Trump in the “art of the deal.”

Brown and Senate president pro tem Kevin de Leon had a particularly tough time in the legislature’s upper chamber. But they did what to be done, according to the Los Angeles Times:

“Democratic Sen. Steve Glazer of Orinda voted against the bill, saying his constituents were against higher taxes as proposed by a 2-1 margin. But Brown and De León persuaded Republican Sen. Anthony Cannella of Ceres to vote in favor of the measure, reaching the two-thirds vote needed for passage.

“The governor and legislative leaders ended up giving nearly $1 billion to specific transportation projects in the districts of legislators who had been on the fence before voting for Senate Bill 1. Brown and De León agreed to provide $500 million for projects in Cannella’s district, including the extension of a commuter rail line from the Bay Area to Merced.

“’At the end of the day I asked for certain things and they delivered them, so I needed to vote for it,’ Cannella told reporters afterward.”

In another sign that Brown and company were paying attention to the arguments against their package, it included a call for a 2018 ballot initiative to prohibit the legislature from diverting the new revenues to other uses.

And it all got done before the legislature’s spring recess, and in time for Jerry Brown’s 79th birthday celebration today.

The man once known as “Governor Moonbeam” is pretty down to earth after all.


April 6: GOP Getting Worried About “Safe” Kansas U.S. House Seat

We all know there’s a red-hot special congressional election in Georgia April 18. But a week earlier, Kansans go to the polls in another “special” that was supposed to be a snoozer. Now Republicans are getting jittery, as I discussed at New York:

It’s an old story by now that Republicans are jittery about holding onto the Georgia U.S. House seat once held by Newt Gingrich and Johnny Isakson, and mostly recently by HHS Secretary Tom Price, in an April 18 special election. But it’s another thing altogether to learn that Republicans are worried about a special election a week earlier in Kansas to replace CIA director Mike Pompeo. Here’s the news from Politico:

“The NRCC is pouring money into a last-minute TV ad buy in Kansas ahead of a Tuesday special election, seeking to pump up Republican enthusiasm and turnout in a district that President Donald Trump carried by 27 percentage points just a few months ago.

“The late independent expenditure seeks to boost Republican state Treasurer Ron Estes …. Kansas Republicans are fretting that Estes’ margin is closer than expected in his race against Democrat James Thompson, an attorney.

“’Kansas should not be in play, but Kansas is in play,’ said one Kansas Republican consultant.”

Yikes.

Just last month the authoritative Cook Political Report rated this race “Safe Republican.” And no wonder: Aside from Trump’s margin in the 4th district of Kansas, Pompeo won it two-to-one last November, and it hasn’t gone Democratic in a presidential or House election since 1992….

[M]aybe GOPers are just getting jumpy, or maybe they are seeing something in Kansas and elsewhere in their own ranks that suggests underwhelming turnout. The NRCC ad, which basically calls Thompson an enthusiastic baby-killer, is about as subtle as an electric cattle prod plunged into the bathwater of GOP base voters.

If the idea is that Republicans need to beat expectations in all these special elections to avoid a buzzkill for the troops or a Twitter screed from the White House, the NRCC going medieval on Thompson makes some sense. But if they’re really worried about losing KS-4, that should terrify Elephant-Party people everywhere.


March 31: Opposition to Medicaid Expansion: It’s Not the Money, It’s the Ideology

There was a brief flurry of excitement this week about the possibility of more states accepting the Affordable Care Act’s Medicaid expansion. I poured some cold water on the idea at New York:

The train wreck involving the American Health Care Act in the U.S. House last week offered a burst of fresh hope to those in the 19 states that have not yet accepted the Medicaid expansion authorized by the Affordable Care Act and made optional by the U.S. Supreme Court. Most versions of GOP health legislation have canceled the expansion and its generous federal funding with variations in terms of speed and ferocity. The version of AHCA that slipped and fell while approaching the House floor contained a flat prohibition on any new expansions, reportedly at the behest of the House Freedom Caucus.

Coincidentally or not, early this week a coalition of Democrats and moderate Republicans in the Kansas legislature sent conservative governor Sam Brownback a bill designed to make that state the 32nd to expand Medicaid eligibility to poor people without children or disabilities…. But alas for any sense of momentum for Medicaid expansions, Brownback promptly vetoed the legislation, with a message that should remind everyone that rejection of the expansion has often been about ideology rather than money:

“I am vetoing this expansion of ObamaCare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs.

“Most grievously, this legislation funnels more taxpayer dollars to Planned Parenthood and the abortion industry. From its infancy, the state of Kansas has affirmed the dignity and equality of each human life. I will not support this legislation that continues to fund organizations that undermine a culture of life.”

Alrighty then!

Vox has just conducted a quick survey of the non-expansion states and didn’t find much new activity despite some optimistic talk from expansion proponents. Virginia governor Terry McAuliffe has launched a new Medicaid-expansion campaign, but unless Democrats make gains in the legislature he will continue to be blocked. In Maine a ballot initiative has already been certified for November of this year to force an expansion that Governor Paul LePage has bitterly opposed.

There’s some mysterious talk in Georgia about Governor Nathan Deal’s administration approaching former Georgia congressman and now HHS Secretary Tom Price for “major changes” to the Medicaid program. Under HHS’ previous management, this might have been an allusion to one of those deals the Obama administration encouraged whereby states were given waivers to conduct conservative policy experiments with the entire Medicaid program in exchange for grudgingly accepting expansion and the massive federal funding that accompanied it. Since the Trump administration doesn’t support the expansion in the first place, it’s unlikely that it will be interested in bribing additional states into going along. It’s more likely Georgia will seek and perhaps receive permission to do unpleasant things to the existing Medicaid population.

All in all, the AHCA fiasco removed a big new disincentive to additional Medicaid expansions. But it didn’t remove the determination of conservatives in many states to reject free money to achieve better health coverage on grounds that it would benefit the undeserving, or make government too popular. That’s a forever thing.


March 30: A Health Care Zombie Apocalypse?

Just when you thought it was safe to write a firm post mortem of GOP efforts to repeal and replace Obamacare this year, strange growling noises emerged from Congress and the White House. I wrote about them at New York.

It seems the source of this alleged reanimation may be the GOP faction most attributed as causing Trumpcare’s death — hard-core conservatives associated with the House Freedom Caucus. Just before the story broke of renewed high-level GOP meetings on health care, Representative Mo Brooks, a Republican from Alabama and a Freedom Caucus bravo who was an announced opponent of AHCA, let it be known he was filing a “discharge petition” to force a House vote on a simple Obamacare repeal (presumably similar to what Congress passed last year in the safe knowledge Barack Obama would veto it). It’s an extreme, long-shot measure to bypass the committee system and the leadership, made sensible only by the Freedom Caucus’s dogmatic belief those enslaved by Obamacare would rattle their chains and bellow their support for such a measure.

While it’s unclear whether Brooks’s determination to force health care back onto the GOP agenda had anything to do with it, something must have sent an impulse into the slowly cooling cadaver of the dead bill. According to the New York Times, there’s activity across the full spectrum of Republican opinion, with the unlikeliest ringleader of all:

“The new talks, which have been going on quietly this week, involve Stephen K. Bannon, the president’s chief strategist, and members of the two Republican factions that helped sink the bill last week, the hard-right Freedom Caucus and the more centrist Tuesday Group.”

It is abundantly unclear how these talks will fare any differently than earlier talks that exposed the deep divide between conservatives who thought AHCA was too generous and “moderates” who though it was too stingy, particularly since every available compromise seemed to make the disastrous coverage and cost numbers the Congressional Budget Office assigned to the legislative product even worse. Bannon’s involvement is even stranger, though obviously if he were able to pull off a legislative feat that eluded Paul Ryan, the cheering in Breitbart-land would be ear-shattering.

The story keeps getting odder. At his daily press briefing yesterday, Sean Spicer provided his usual clarity when asked about the reported revivification:

“Staff has met with individuals and listened to them….
Have we had some discussions and listened to ideas? Yes. Are we actively planning an immediate strategy? Not at this time … So there has been a discussion and I believe there will be several more.”

Paul Ryan, probably wanting to make it clear Bannon hasn’t cut him out of the picture, churned still more fog into the air:

“We want to get it right,” Speaker Paul Ryan told reporters after a GOP conference meeting Tuesday. “We’re going to keep talking to each other until we get it right. I’m not going to put a timeline on it, because this is too important to not get right and to put an artificial timeline on it.”

Meanwhile, Ryan’s Senate counterpart, Mitch McConnell, was having nothing of it:

“Mcconnell [sic] making clear Obamacare repeal efforts dead. ‘We have the existing law in place and we’ll just have to see how that works out.'”

If that’s not enough Republican confusion for you, there are fresh reports today that some GOP senators don’t agree with McConnell, and remain interested in moving their own repeal-and-replace legislation, independently from what the House is thinking about doing.

And to top it all off, the president of the United State told a bipartisan group of senators last night that enacting a health-care bill was going to be a snap:

“I know that we are all going to make a deal on health care.

“That’s such an easy one.”

All this talk had better materialize into action pretty quickly, or it may be too late. Anti-abortion activists are already eyeing the abandoned reconciliation instrument that was supposed to make passage of Trumpcare easier, and demanding that it be used for their pet cause, the defunding of Planned Parenthood, so that that item won’t wind up being filibustered by Democrats as part of a stopgap appropriations bill. For those still discussing health-care legislation, it’s use-it-or-lose-it time. The dead can’t walk much longer.


March 24: And The Next GOP Health Plan Will Be: How About Never? Does Never Work For You?

In the wake of the rapid and total collapse of the American Health Care Act today, I sat down to write at New York about the GOP’s health care policy options going forward, before realizing there might not be any. Here were my thoughts:

The good news for Republicans that nobody much appreciates right now is that there was nothing mandatory about this whole messy enterprise. Yes, if they just give up on enacting a budget-reconciliation bill for fiscal year 2017 (that’s technically what the American Health Care Act is), they will defy the “instructions” they gave themselves back on January 13 when they enacted the budget resolution that put this runaway train in motion. Yes, there are both political and fiscal consequences for just bagging it. But there’s no judge who will fine them for it. So technically, the president is right: They can “move on,” and they can “punish” the American people by letting the Affordable Care Act stay in place.

And there was certainly nothing in Speaker Paul Ryan’s press conference after the bill was pulled to suggest any present intention to go back to the drawing board and come up with another bill. He admitted repeatedly that Obamacare would be in place “for the foreseeable future.” And then Donald Trump put the lid on the coffin by repeatedly saying nothing would happen on health care until Democrats joined in after Obamacare “explodes.”

Barring some second wind for a repeal/replace effort, or the unquenchable possibility that Donald Trump will change his mind, it will probably become an agenda item that slips into the future, or at least until 2018. The possible exception, particularly if the current system of individual health insurance continues to struggle with higher premiums and the withdrawal of insurers from purchasing exchanges, would be for Republicans to ask Democrats to cooperate in some sort of “fix” that they could market as sort of repeal-and-replace on the cheap.

Is it possible Democrats would be interested in this sort of deal once they finish celebrating the implosion of Trumpcare? Probably not anytime soon. The only vehicle for a bipartisan compromise at the moment is the Cassidy-Collins proposal that lets states decide whether to stick with Obamacare (including the Medicaid expansion) or move in a more conservative direction. This might have been enticing to some blue-state governors and Members of Congress back when it looked like Republicans had the means to enact something far more draconian. But at the moment it would look like a betrayal of Democratic constituencies in red states.

What might happen instead is that Republicans, freed from the responsibility of actually enacting anything, which their trifecta and the budget reconciliation made possible, will retreat to proposing impracticable health-care legislation they know Democrats won’t support and can easily filibuster. It will be just like Obama is still president and Republicans could demagogue on health care to their hearts’ desire!

In the short term, Republicans will have to deal with some immediate challenges exacerbated by this fiasco, like the need to satisfy their anti-abortion constituents by “defunding” Planned Parenthood, pursuing a tax-cut package without the improved revenue “baseline” that AHCA would have provided, and finding a new vehicle for “reforming” Medicaid (i.e., capping federal expenditures).

From a longer perspective, Republicans now understand how Democrats felt when the Clinton Health Plan went down to defeat in 1994. If it takes them half as long as it took Democrats to take another swing for the fences on health-care policy, we won’t soon see any vindication of the doomed effort that died today.


March 23: TrumpCare Hits Dead End, Or At Least Cul-De-Sac

Near the end of a crazy week in Washington, Republicans just postponed a House vote on their “must-pass” health care plan. I offered a quick explanation at New York.

[I]t was not terribly surprising given the news from a White House meeting earlier today between Donald Trump and members of the conservative House Freedom Caucus, wherein Trump made a “final offer” and very few HFC folk bought it.

It had appeared Wednesday night that Trump and Paul Ryan might have found a way to blow this flawed bill out of the House by promising to include the repeal of Obamacare’s list of “essential benefits” heath plans needed to provide to qualify for federal subsidies (the list includes ten key categories, such as hospitalization, emergency services, and pregnancy care). That had previously been thought to be an unavailable concession thanks to Senate rules limiting budget reconciliation bills to budget-germane provisions. But those backing TrumpCare were now offering assurances (backed up by Sen. Mike Lee, a key Senate conservative who had opposed the original AHCA) the Senate parliamentarian would play ball with this broader bill. So presumably conservatives who wanted more of a complete repeal of Obamacare could, in theory, vote for the bill in the House and then vote against the final House-Senate conference report in case the reports about the parliamentarian’s flexibility were in error or just a ruse.

But the gambit backfired when HFC members meeting with Trump pocketed the “essential benefits” concession and demanded more. According to one account, they wanted even highly popular provisions like protections for people with pre-existing provisions and allowing dependents up to age 26 going on their parents’ policies to be repealed. Regardless of the exact demands, it’s clear conservatives called Trump’s and Ryan’s bluff: if all Obamacare regulations are now on the table, why stop with one or two?

Indeed, even before the vote cancellation, influential conservative commentator Ramesh Ponnuru was arguing that the new information about the parliamentarian meant Republicans should rethink the whole bill, not rush it out of the House. And if nothing shakes loose in the next few days, that may be the new GOP excuse for additional delay.

The trouble is this: even if these reports are right and Republicans don’t have to wait for some improbable second or third “prong” of regulatory or legislative action to get rid of Obamacare, GOP conservatives and “moderates” don’t agree at all on which provisions to trash and which to keep. And the search for a compromise won’t be improved by a fight over features of the bill that could easily be understood and “scored” as making life worse for real-live categories of people now benefiting from the Affordable Care Act.

For now Republicans at both ends of Pennsylvania Avenue have reached a cul-de-sac on health care and need either to turn around and try a different path or pull off some sort of politically dangerous minor miracle. This very bad week for Donald Trump has gotten a lot worse, and for once Paul Ryan is his full partner in misery.

Stay tuned for more GOP health care madness.