Today President Trump, House Speaker Paul D. Ryan (R-Wis.), moderate House Republicans and Freedom Caucus Republicans risk their jobs, their credibility and their agenda. How could this have gone differently, without the potential for political self-immolation? Consider some alternative scenarios. In the first, Trump could have stuck to his campaign populist themes. Rather than defer to Ryan and to Health and Human Service Secretary Tom Price (whose plan was essentially what Ryan had in mind all along), he could have put forth a populist- styled plan: Keep the taxes on the rich, put additional money into funding state- based reinsurance plans for high-risk individuals, encourage insurers to reenter the exchanges either by reopening the risk corridors or by altering the 80-20 rule and look to GOP governors for a Medicaid reform plan that allows expanded coverage in exchange for state flexibility in program design. Trump could also have followed through on his promise to allow the federal government to negotiate directly with drug companies.
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