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.

Alex Carp has a revealing interview with Ruy Teixeira, author of influential political books, including “The Optimistic Leftist: Why the 21st Century Will Be Better Than You Think” and (co-author with John Judis) of “The Emerging Democratic Majority,” at New York Magazine’s Daily Intelligencer. In one section of the interview Teixeira talks about the problems of the Clinton campaign messaging  strategy, and the implications for the future.

…Look at Hillary Clinton’s platform, for example, and the things she was supposedly running on. She actually had a lot of pretty good ideas for things that would benefit white non-college-graduates, even ideas that were specific to those areas of the country where they’re concentrated. But she didn’t talk about them; she didn’t even go to these places, by and large.

In fact, she didn’t really talk about policy. There’s a now well-known study of campaign advertising that showed Hillary Clinton was at a historically low level. She spent money like crazy — she way outspent Donald Trump, but the advertising was all about how Trump was not a progressive, he wasn’t a good guy, he didn’t like black people and Latinos and immigrants, and he’s intolerant, his issues with women, and so on. But very little of it was about what she actually would do for people, what her policies were.

As far as messaging goes, Clinton talked quite a lot about economic issues and reforms in her speeches. But, as Teixeira points out, her ads were much more focused on criticizing Trump. Perhaps one of the lessons of the 2016 presidential campaign is that campaign speeches are generally not well-covered. Indeed, when you see campaign speech coverage on television news, it’s usually a very short soundbite, and not always the best one. Clinton’s speech coverage was further undermined by Trump’s almost daily bomb-throwing tweets. Thus, speeches are good for rallying the host audience, but not so much for influencing swing voters nation-wide. Ads may be more powerful for meeting this last challenge, and candidates must use them to pitch their policies and vision, not just to beat up on the adversary.

Teixeira is more hopeful about the future:

I think that’ll be corrected. Is there a single policy or two policies that they’ll talk about? I don’t know. But I think there’s going to be a lot of ripe targets from the first two years of the Trump administration, in terms of them doing and saying things that are directly an attack upon those people. And these voters voted for Trump because they thought he was going to solve their problems. This is something that the left should hang on to with tenacity. Don’t typecast these voters as voting for Trump just because he had reactionary views on immigration or race or what have you. These voters want their lives to be better, and they thought that Trump could make it better. When this doesn’t happen, when things don’t get a lot better, and in fact when things might even get worse in some ways, that’s an opening.

Asked “Do you think the recent wave of outreach to white working-class voters by Democratic strategists and thinks tanks is smart?,” Teixeira responds:

I do, I do. There is some debate about this, obviously. There are people who have made the case that essentially these voters are hopeless and that the real problem is not investing enough in mobilizing base Democratic voters, but I think that’s crazy, basically. Clearly, you can and should do both!

Any party worth its salt mobilizes its base, and it would be silly not to. But I think it’s political malpractice not to go out there and try to narrow your deficits among these very large groups of people in very important parts of the country. And if it requires somewhat more resources than you’ve been investing to do it, of course you should do it. I mean, I don’t even think it should be much of a debate.

Earlier in the interview Teixeira acknowledges that “even though the Democrats represented more people, they were inefficiently distributed for political purposes,” as a result of systemic problems, including gerrymandering, the small state advantage Republicans enjoy in the Senate and the distortion of voting power in the Electoral College — all of which have undercut the political advantage of demographic trends favoring Democrats.

Democrats now appear to be much more attentive to addressing these structural problems, and hopefully, a little wiser about what issues and vision to emphasize in campaigns. Add to that the growing rifts in the GOP, and Democratic prospects for 2018 and 2020 look much improved than was the case just after the election.

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.

Ariel Edwards-Levy reports on polling data regarding the nomination of Neil Gorsuch to the U.S. Supreme Court at HuffPo, and finds: “Americans say by a 17-percentage-point margin, 40 percent to 23 percent, that Gorsuch, the federal appeals judge nominated by President Donald Trump to fill the seat left vacant by the death of Antonin Scalia, should be confirmed. An additional 37 percent aren’t sure. (A poll taken after Gorsuch’s nomination was first announced in February found that Americans favored confirmation by a similar 15-point margin, 43 percent to 28 percent, with 29 percent undecided.)…Voters who supported Trump are overwhelmingly aligned in favor of Gorsuch: 87 percent think the Senate should confirm him, and just 3 percent say that it shouldn’t. In contrast, while most Clinton voters oppose the nomination, they do so less strongly. Fifty-four percent don’t want the Senate to vote to confirm Gorsuch, but 17 percent say that it should, and 29 percent say that they aren’t sure…While health care tops the list of Americans’ biggest concerns, recent polling suggests, the Supreme Court currently lags near the bottom ― and while Hillary Clinton voters in the presidential election rallied strongly against the health care bill, which Trump voters supported only tepidly, the intensity gap seems to be reversed when it comes to Gorsuch’s confirmation…Less than half of the public reports following the confirmation hearings even somewhat closely, with just 14 percent saying they’ve followed the proceedings very closely.” It looks like public disinterest in Supreme Court nominations is all out of proportion to the importance of who will be the next swing vote on the high  court. Arguments about the slippery Gorsuch appear to be mostly framed in terms of his anti-worker, pro-corporate views, along with his unsavory eagerness to personally benefit from the GOP’s outrageous refusal to grant Merrick Garland a fair hearing. Call it at least tacit collaboration with grossly-partisan suppression of open debate – a cornerstone principle of democracy. The question is how to make this concern more of an issue of public concern.

Mounting evidence that Judge Neil Gorsuch would be another rubber stamp favoring employers against worker rights on the Supreme Court raises increasing concerns among union leaders. “The current eight members of the U.S. Supreme Court unanimously disagreed last week with the measly educational standard Gorsuch set. In the case of Endrew F. vs Douglas County, Chief Justice John G. Roberts Jr. wrote that a school district has a duty under the law to provide such children with “an educational program that is reasonably calculated to enable [them] to make progress” and that the program “must be appropriately ambitious.”…To Gorsuch, Alphonse Maddin is not a man, but a “trucker.” In Gorsuch’s world, an autistic child is not a human deserving an education. In his mind, a college professor relinquishes personhood when she falls ill. Gorsuch’s perverse propensity to discount humanity makes him unfit for the court. A soulless man cannot serve justice.” –from “Gorsuch on Labor: A Soulless Man Cannot Serve” by  Leo Gerard, president of the United Steelworkers, at OurFuture.org.

In addition to Gorsuch’s bias against worker rights, Robyn Thomas and Adam Skaggs explore the reasons why the “Gun Lobby May Have Their Man in Neil Gorsuch Supreme Court nominee” at Newsweek, while Melanie Campbell’s “Neil Gorsuch’s Frightening Record on Protecting Women’s Rights” at NBC  News has a good summary of what women stand to lose if Gorsuch is confirmed and Arn Pearson eplains why “Gorsuch Would Move the Supreme Court in the Wrong Direction on Money in Politics.”

At The Washington Post, Amber Phillips, Darla Cameron and Kevin Schaul report “29 Democrats oppose Gorsuch’s nomination and say they will block it from getting to a full vote. They need to successfully block him with a filibuster.” Senators who are still undecided about using the filbuster to block Gorsuch include: Michael F. Bennet (Co); Richard Blumenthal (Conn.); Sherrod Brown (Ohio); Maria Cantwell (Wash.); Benjamin L. Cardin (Md.); Christopher A. Coons (Del.); Catherine Cortez Masto (NV); Joe Donnelly (Ind.); Tammy Duckworth (Ill.); Dianne Feinstein (Ca); Heidi Heitkamp (N.D.); Angus King* (Maine); PatrickbJ. Leahy (Vt.); Claire McCaskill (Mo.); Robert Menendez (N.J.); Brian Schatz (Hawaii); Jon Tester (Mont.); and Mark R. Warner (Va).

From The Atlantic, this approach merits more experimentation among Democratic ad-makers, as well as Facebook-users, who are more interested in changing attitudes than preaching to the choir:

At New York Magazine Ed Kilgore has “9 Big Questions About GOP Tax Reform” including, “(2) How about Democrats? Will they be consulted? As with health-care legislation, tax-reform legislation will be pursued through special budget procedures so that it can be enacted by simple majorities in both houses without the possibility of a Senate filibuster. That means congressional Democrats will be pure bystanders unless something big goes wrong, at which point the whole exercise may be scaled back if not abandoned. The flip side of that situation is that Democrats will be free to take pot shots at the legislation as simply representing a bonanza for the rich and powerful and an implicit betrayal of the working-class people who voted for Trump.”

There’s an important message for Democrats and progressives in the agreement to repeal North Carolina’s odious bathroom law. It is that boycotts can decisively strengthen campaigns for political change. Marc Tracy reports at the New York Times that “An Associated Press study released this week found that over a dozen years House Bill 2 could cost North Carolina nearly $4 billion because of canceled events.” In this case, progressive organizers skillfully leveraged N.C.’s basketball obsession, ‘March madness’ and business community concern to compell a Republican-dominated state legislature to reverse itself.

Alex Byers reports at Politico on another issue that may spell disaster for Republicans: “Congressional Republicans drew blood this week by voting to repeal the Federal Communications Commission’s Obama-era broadband privacy rules. The GOP’s next target is likely to be the Obama administration’s top technology legacy: net neutrality rules that essentially require internet providers to treat all Web traffic equally, a policy championed by Silicon Valley.,,Even in a Capitol often dominated by fights over defense or health care, the GOP’s technology offensive has handed a potential political weapon to Democrats and consumer groups, who are eager to use it. Democrats followed Tuesday’s privacy vote by launching broadsides against GOP Sens. Jeff Flake of Arizona and Dean Heller of Nevada, supporters of the privacy repeal who face reelection in 2018 — denouncing the GOP work as “creepy” and “indefensible.”…“Voters across party lines understand the importance of personal privacy and are not going to be happy as they find out that Republican senators and Senate candidates used a party-line vote to put data including health and financial information for sale to the highest bidder,” said Ben Ray, a spokesman for the Democratic Senatorial Campaign Committee…”We think the Open Internet Order has been good for the public, good for consumers, and we think it’s tremendously popular with people, too,” said Rep. Mike Doyle (D-Pa.). “While they have the power and authority to do it, I just think they’re going to pay a heavy price if they keep moving in the direction they’re moving.”

Early voting is already underway in the much-monitored special election for Georgia’s 6th congressional district, where Democrat Jon Ossoff leads in polls to replace former Rep. Tom Price, Trump’s Secretary for Health and Human Services. Nate Cohn has an update at The Upshot, explaining “Why Democrats Have a Shot in a Georgia District Dominated by Republicans,” and notes, “So far, 55 percent of early voters in the special election — either in-person or absentee — have most recently participated in a Democratic primary, while just 31 percent have most recently participated in a Republican primary. For comparison, just 23 percent of voters in the district in the 2016 general election had most recently participated in a Democratic primary, compared with 46 percent in a Republican primary…The huge Republican field probably helps the early Democratic turnout edge: Republican voters are less likely to know at this stage whom they’re going to vote for. But the Democrats also enjoy a similar 45-to-21-point edge among the larger group of voters who have requested but not yet returned absentee ballots…These sorts of lopsided turnout advantages aren’t sustainable in a high-turnout presidential election or even a midterm. But in a low turnout election like this, it doesn’t take much to generate a meaningful turnout edge.”

In Nate Cohn’s post “A 2016 Review: Turnout Wasn’t the Driver of Clinton’s Defeat” at The Upshot, he mines data indicating that, in the 2016 presidential election, “the turnout was only modestly better for Mr. Trump than expected,” and “To the extent Democratic turnout was weak, it was mainly among black voters. Even there, the scale of Democratic weakness has been exaggerated.” Further,

Instead, it’s clear that large numbers of white, working-class voters shifted from the Democrats to Mr. Trump. Over all, almost one in four of President Obama’s 2012 white working-class supporters defected from the Democrats in 2016, either supporting Mr. Trump or voting for a third-party candidate.

This analysis compares official voter files — data not available until months after the election — with The Upshot’s pre-election turnout projections in Florida, Pennsylvania and North Carolina. The turnout patterns evident in these states are representative of broader trends throughout the battleground states and nationwide.

The turnout was slightly and consistently more favorable for Mr. Trump across all three states. But the turnout edge was small; in one of the closest elections in American history, it might not have represented his margin of victory.

Cohn explains that “the black turnout was roughly in line with our pre-election expectations.” However, “On average, white and Hispanic turnout was 4 percent higher than we expected, while black turnout was 1 percent lower than expected.” African American turnout,  Cohn notes, “was significantly lower than it was four or eight years ago, when Mr. Obama galvanized record black turnout,” but not far our of line with what pre-election studies anticipated.

Cohn cites a broad increase in white voter turnout “among young voters, Democrats, Republicans, unaffiliated voters, urban, rural, and the likeliest supporters of Mrs. Clinton and Mr. Trump.” But “The greatest increases were among young and unaffiliated white voters.” Cohn adds that “The turnout among young and white Democratic voters was quite strong,” and he sees a slight edge for Trump in voter enthusiasm among his supporters. “Over all, the turnout among white voters with a greater than 80 percent chance of supporting Mr. Trump was 7 percent higher than expected, while the turnout was 4 percent higher among white voters with greater than an 80 percent chance of supporting Mrs. Clinton.”

“If turnout played only a modest role in Mr. Trump’s victory,” concludes Cohn, “then the big driver of his gains was persuasion: He flipped millions of white working-class Obama supporters to his side…The voter file data makes it impossible to avoid this conclusion.”

None of this is to argue that Democrats wouldn’t benefit from a more effective effort to turn out their base. It’s just a description of what really happened in the November elections. But it does corroborate the argument that Trump secured his electoral college victory in the predominantly white working-class precincts of the battleground states.

A few things to remember in mulling over Cohn’s conclusions: Clinton won the popular vote by a nearly 3 million vote margin, and the popular vote winner has been elected President in all but a very few elections. Monday morning quaterback generalizations about her campaign strategy should be considered in that light; Secondly, be a little skeptical of pundits spinning Cohn’s findings into an argument that Democrats must reconfigure their strategy to win a “majority of the white working-class.” In reality, Democrats need only a larger piece of this constituency, and a ten percent improvement in a few states would likely have been adequate in 2016; and, thirdly, Trump was poster-boy for an unusual presidential candidate, and it’s hard to see how future Republican candidates will be able to get away with similar shenanigans — especially considering the litany of disasters that have defined his first 100 days.

Now that the Affordable Care Act has been granted a stay of execution, Democrats have a unique opportunity to once again get in front of health care reforms that can win the support of working-class voters of all races. The extremely weak public support for the GOP ‘repeal and replace’ bill (just 17 percent in the recent Pew Research poll) indicates that there is simply no chance whatsoever that the Republicans might provide credible leadership on the issue. Democrats alone have the capacity to build a majority consensus in support of specific reforms needed to strengthen Obamacare, and they should seize the political moment to do so.

Republicans will now try to destroy Obamacare by a thousand cuts, and they do have some worrisome weapons at their disposal, including appropriations and executive orders. They may have some success, but ultimately these battles will be sorted out in the courtroom and the courts of public opinion, where alert Democrats will have the edge. But the challenge here is not so much to react effectively, as to get pro-active and claim ownership of mending Obamacare, while their GOP adversaries continue muck about in their swamp of unproductive ideological excess.

In his Washington Post opinion article, “Democrats should offer solutions, not silence, on health care,” James Downie writes:

Rather than stay on the sidelines, Democrats in Congress should introduce and promote a new health-care plan. The outlines of such a plan are straightforward: expand Medicare and Medicaid, create a public option for everyone else that can use those programs’ pricing power, push regulatory reforms to lower drug prices, and give Medicare the power to negotiate prescription drug prices. Many progressives would prefer a Medicare-for-all system, but this plan would satisfy most of the party, and it has the political advantage of being closely tied to the extremely popular Medicare program.

Those are generally good ideas. but the wisest course may be to not pitch “a new health care plan,” which would be unnecessarily complex, and might cause many time-challenged voters to tune out. Polls now indicate that the public sees Obamacare as a good start, but they believe it needs improvements. Instead of a big, new package, the improvements could be pitched as a series of specific, easily-digestible amendments, one at a time, where possible. That approach has a better chance of securing gradual voter “buy-in,” than does glazing over the eyes of citizens who are still trying to understand the provisions of the ACA. Voters at this political moment don’t want a big honking radical re-do, with lots of bells and whistles; They want credible easy-to-understand reforms, served up in intelligible portions.

Such an approach has the additional virtue of rendering impotent one of the GOP’s most powerful weapons — distraction. By staying on a simple bill, such as an amendment lowering the age for Medicare, or broadening eligibility for Medicaid, or price controls for commonly-used drugs, Democrats can improve the odds that voters will pay attention to the merits of their proposals. Other needed fixes for Obamacare include further reducing the burdens of deductibles and premium costs. As soon as one reform is enacted, Democrats should immediately introduce another.

Republicans have an edge in debates about big package reforms, because they are practiced in distraction. Democrats should not play by their rules. Breaking down needed reforms and presenting them clearly shows respect for health care consumers, and makes it easier for them to identify which elected officials serve their interests, instead of insurance company profits. None of this is intended as a way to head off single-payer or Medicare for all. Rather it is a way to get there, step by achievable step.

Sen. Bernie Sanders, quoted in Lisa Rathke’s AP article, “Sanders says he’ll introduce ‘Medicare for all’ bill,” offers this perceptive observation about the Republican health care melt-down: “It wasn’t just we defeated them,” Sanders, an independent, said. “It was how we defeated them,” with rallies around the country, town meetings and people standing up and fighting back.” Many political commentators slighted the nation-wide protests leading up to and continuing after the inauguration, arguing that they meant little, unless they mobilized voters. But the protests did matter, because they educated millions of Americans about the huge rip-off embedded in the Republican ‘repeal and replace’ bill. But, yes it would be even better if the protest campaigns also registered voters.

In his PowerPost article, “Left out of AHCA fight, Democrats let their grass roots lead — and win,” Dave Weigel concurrs, and notes, “Democrats watched as a roiling, well-organized “resistance” bombarded Republicans with calls and filled their town hall meetings with skeptics. The Indivisible coalition, founded after the 2016 election by former congressional aides who knew how to lobby their old bosses, was the newest and flashiest. But it was joined by MoveOn, which reported 40,000 calls to congressional offices from its members; by Planned Parenthood, directly under the AHCA’s gun; by the Democratic National Committee, fresh off a divisive leadership race; and by the AARP, which branded the bill as an “age tax” before Democrats had come up with a counterattack…And what was incredible about this process was the phone calls,” said Rep. Raja Krishnamoorthi (D-Ill.)…We had 1,959 phone calls in opposition to the American Health Care Act. We had 30 for it.””

But Democrats should not be content merely to defend Obamacare. Rather they should energetically reframe the Debate into expanding access to Medicare and Medicaid. As Daniel Marans writes at HuffPo, “Single-payer health insurance still lacks support from many, if not most, Democrats, let alone from the Republican lawmakers who control both chambers. But the proactive strategy speaks to increasing confidence among progressives that if they stick to their ideals and build a grassroots movement around them, they will ultimately move the political spectrum in their direction…In the meantime, a potential benefit of this ambitious approach is what’s known as shifting the “Overton Window,” a political science term for the narrow range of acceptable political views at a given moment in time…By adopting a position that is considered extreme by contemporary standards, politicians and activists can make more attainable policy goals start to seem reasonable by comparison. That phenomenon already seems to be working in progressives’ favor…Lowering the Medicare eligibility age from its current level of 65 is a “very interesting” idea, because of the positive financial effect it would have on the Obamacare insurance exchanges, said Austin Frakt, a health economist for the Department of Veterans Affairs…By allowing the oldest exchange participants to enroll in Medicare, lowering the Medicare age would relieve the health insurance marketplaces of some of their costliest customers, said Frakt, who also has academic posts at Boston University and Harvard…“It would reduce the premiums in those markets,” he predicted. (Frakt noted, however, that absent measures to offset the cost of the additional beneficiaries, the change would increase Medicare’s financial burden.)..Social Security Works’ Lawson praised the idea as an incremental step toward Medicare for all…“Start by lowering the age to 62 and get it down to zero,” he said.”

In another Dave Weigel article, “With AHCA defeat, some Democrats see chance to push for universal coverage,” he shares a quote from Sen. Sheldon Whitehouse that should become a talking point for all Democratic candidates: “The very best market-based solution is to have a public option,” Whitehouse said. Paraphrasing Benjamin Franklin, he said that a government-managed insurer would reveal what games private insurers had been playing. “The best way to show that a stick is crooked is to put a straight stick next to it. If you do that, the private sector can’t manipulate the market by withdrawing.”

Robert H. Frank, an economics professor at the Johnson Graduate School of Management at Cornell University looks beyond the public option in “What Comes Next for Obamacare? The Case for Medicare for All” at The Upshot. As Frank writes, “American health care outlays per capita in 2015 were more than twice the average of those in the 35 advanced countries that make up the Organization for Economic Cooperation and Development. Yet despite that spending difference, the system in the United States delivers significantly less favorable outcomes on measures like longevity and the incidence of chronic illness…But advertising expenses and administrative costs are not the most important reason the United States spends so much more. The main difference is that prices for medical services are so much lower in other countries. In France, for example, a magnetic resonance imaging exam costs $363, on average, compared with $1,121 in the United States; an appendectomy is $4,463 in France, versus $13,851 in America. These differences stem largely from the fact that single payers — which is to say, governments — are typically able to negotiate more favorable terms with service providers…In short, Medicare for all could deliver quality care at much lower cost than private insurers do now. People would of course be free to supplement their public coverage with private insurance, as they now doin most other countries with single-payer systems, and as many older Americans do with Medicare.”

Rep. Keith Ellison has a statistic that Democratic candidates and campaigns need to ponder. As Jeff McMenemy writes at seacoastonline.com, “Ellison, deputy chairman of the Democratic National Committee, told a crowd of several hundred people that packed a fundraiser at the Portsmouth Gas Light Co. restaurant, that 63 percent of Americans “do not have $500 bucks in the bank. Think about that…A little crisis comes up and it can throw your family budget all out of whack. It means you get to the end of the week and you ran out of money,” Ellison said Saturday afternoon. “People are living paycheck to paycheck. Those Americans need a party that will fight for them.””

At The New York Times Jonathan Martin observes that Democratic leaders are not about to be hustled by another tax break for the wealthy scam masquerading as an infrastructure initiative. “An infrastructure plan may be a safer harbor for Mr. Trump — a measure many in Washington are mystified that he did not try to pursue at the outset of his administration,” writes Martin. “But Mr. Schumer suggested that the president would find Democratic votes only if he defied his party and embraced a huge spending bill, rather than just offering tax incentives for companies to build roads, bridges and railways…“If he’s only for tax breaks, it will just be a repeat of the health care debate,” Mr. Schumer said.”

The New Yorker’s Jeffrey Toobin has a warning for Democrats who may be softening up toward the Gorsuch nomination: “To the extent that Gorsuch said anything of substance at his hearing, he put himself across as a mainstream figure. He said that he had participated in some twenty-seven hundred cases on the appeals court, and had voted with the majority in ninety-nine per cent of them. This proves only that most cases are routine. (Even the Supreme Court issues unanimous rulings more than half the time.) The hard cases are the ones that matter, and it’s reasonable to project how Gorsuch would vote in them. He would oppose abortion rights. (Trump promised to appoint a “pro-life” Justice.) His predilection for employers over employees is such that it yielded a circuit-court opinion of almost Gothic cruelty. When subzero temperatures caused a truck driver’s trailer brakes to freeze, he pulled over to the side of the road. After waiting three hours for help to arrive, he began to lose feeling in his extremities, so he unhitched the cab from the trailer and drove to safety. His employer fired him for abandoning company property. The majority in the case called the dismissal unjustified, but Gorsuch said that the driver was in the wrong…As a Justice, Gorsuch would embrace the deregulation of campaign finance symbolized by the Citizens United decision. (He argued in an opinion that judges should evaluate limits on political contributions using the same tough standards that they apply to racial discrimination.) His most famous Tenth Circuit decision had him taking a side in the culture wars. In Hobby Lobby Stores, Inc. v. Sebelius, he ruled that a multibillion-dollar corporation could withhold federally guaranteed rights to birth control from thousands of female employees because of the religious beliefs of the corporation’s owners. (His position was upheld, 5–4, by the Supreme Court.) In an embarrassing coincidence, on the second day of Gorsuch’s testimony, the Court unanimously rejected one of his holdings in the Tenth Circuit, ruling that it denied adequate educational opportunities to students with disabilities. Every sign suggests that Gorsuch would be at least as conservative a judicial activist as Samuel Alito…It’s also clear what Neil Gorsuch is not: Merrick Garland. Gorsuch’s nomination is inextricable from its shameful political context. When Scalia died, more than eleven months remained in Barack Obama’s Presidency, but Senate Republicans refused to give his nominee even a hearing. This departure from norms was all the more outrageous because the tactic was used to block a moderate; the Republicans denied Obama his constitutional right in order to trade a Justice who might have been less liberal than Stephen Breyer for one who might be as radical as Clarence Thomas. Such a turnabout seems especially disturbing given that the F.B.I. and other agencies are now investigating the very legitimacy of the Trump Presidency. Indeed, Chuck Schumer, the Democratic leader in the Senate, has called for a delay in the Gorsuch vote until there is some clarity about the Trump camp’s ties to Russia. Last week, he also promised to lead a filibuster against Gorsuch’s confirmation, but Republicans, in response, vowed to change the Senate rules to allow them to confirm the nominee by a simple majority.”

“Sitting judges are expected to stay out of electoral politics. But this is not about attending a caucus or writing a campaign check. This is about respect—or disrespect—for the process by which judges are nominated, how those nominations are reviewed and the standards by which they are confirmed or rejected…Gorsuch’s refusal to acknowledge that corruption diminished him. And it further disqualified a man who—if he truly respected the constitution and the court—would have refused Trump’s offer of a tainted nomination…“Judge Gorsuch himself should understand the precedent his nomination risks setting and not hide behind statements about the need to avoid politics,” explains former US Senator Russ Feingold, a three-term veteran of the Senate Judiciary Committee who weighed the nominations of six Supreme Court Justices during his 18 years in the Senate. Of Gorsuch, Feingold says, “He should have refused the nomination. He reportedly called Judge Garland after he was nominated. If he had truly understood what is at stake, he would have called Judge Garland to say he had turned down the nomination in solidarity—not with Judge Garland personally, but with the Supreme Court and the US Constitution that he says he holds in such high regard…By refusing to acknowledge and condemn the chicanery, and the lies, that made him a nominee made himself a part of the lies and corruption…By putting his own political ambition ahead of a duty to the republic, Gorsuch extended the damage done by Republican partisans in 2016. And created a new danger. “If Republicans get away with the judicial coup they launched last year when they refused to grant Judge Merrick Garland a hearing, such a cynical political ploy could become commonplace,” says Feingold. “The GOP will apply it to lower courts. They will refuse to grant a hearing in the year before a midterm, or during the two years of a presidential race. The Supreme Court will become a permanent pawn of the GOP.” — from “Neil Gorsuch’s Own Testimony Clearly Disqualifies Him: The nominee failed to outline even minimal concerns about the GOP’s judicial coup” by John Nichols in The Nation.

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.

Republicans are bracing for a major defeat of their ‘repeal and replace’ health care bill today, and their loss is more likely to be greeted with public cheers than expressions of regret.  In their New York Times article, “Trump Tells G.O.P. It’s Now or Never, Demanding House Vote on Health Bill,” Julie Hirschfield Davis, Robert Pear and Thomas Kaplan note,

A Quinnipiac University national poll found that voters disapproved of the Republican plan by lopsided margins, with 56 percent opposed, 17 percent supportive and 26 percent undecided. The measure did not even draw support among a majority of Republicans; 41 percent approved, while 24 percent were opposed.

That is an absolutely pathetic number, considering all of the time Republicans have had to fashion a ‘repeal and replace’ bill. It is a number that calls into question, not only the political skills of Trump, Ryan and other GOP leaders, but also their common sense, for having manuevered themselves into such an embarrassing spotlight. Really, guys, that’s the best you can do with with GOP control of the White House, U.S. Senate and House?

Trump’s threat to move away from supporting Obamacare repeal is not likely to be all that much of a concern since his approval rating is at 37 percent in the Quinnipiac poll. As Elliot Hannon writes at Slate.com,

If it feels, to you, like Donald Trump is doing a terrible job as president—you’re not alone. Recent polls have shown the president’s support cratering to historic lows, and a new Quinnipiac University poll released Wednesday confirmed Trump’s unpopularity. Trump’s job approval rating stands at 37 percent with a whopping 56 percent of Americans disapproving of the job Trump’s doing. By comparison, nearly two-thirds of Americans approved of Barack Obama at a similar stage, and George W. Bush had an approval rating nearing 60 percent, while roughly 1-in-4 Americans disapproved of the former presidents two months into their first terms.

Then there is the issue of Trump’s credibilty, his pattern of saying anything, often to reverse himself in days, if not hours. For that same reason, Democrats should not expect that he will necessarily abandon the ‘repeal and replace’ effort just because he said so.

It is possible that Speaker Ryan will secure a narrow majority at the last minute, but it is increasingly unlikely. Even if he does pass it in the House, however, the bill faces even stronger opposition in the U.S. Senate. As Heather Caygle and Elana Schor note at Politico, “House Democrats think GOP leaders in the Senate will have a much harder time changing the bill to appease tepid Republican senators.” The authors quote House Minority Leader Steny Hoyer, who observes, “I am as positive as I can be … that Speaker Ryan does not believe this bill will pass the Senate.”

At The Fix Amber Phillips writes in her post, “There are still enough House Republicans opposed to the health-care bill to kill it,” that “Assuming no Democrats support the measure, Republicans can lose two votes in the Senate and 22 votes in the House. As of Thursday night, here’s how many Republicans have said that they’ll vote against it: 34 House members; 6 senators. Other GOP lawmakers still have serious concerns about the legislation or said they are leaning against it. We count 15 House members, 16 senators.”

All in all, it looks like today could be a disaster for Republicans, as they marinate in an unholy stew of threats, insults, whining, excuses, finger-pointing, lies and betrayals, and that’s before the vote count that reveals their party as politically bankrupt. Of course the irony is that Obamacare was their best hope for delaying the public option all along. The GOP’s showcasing the intellectual, moral and political bankruptcy of their health care policy may end up hastening the day when the public option becomes a reality.

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.