Politico reports that congressional Republican leaders want to rein in federal funding for states’ Medicaid programs. The White House (reasonably) fears the politics of that proposal and is instead interested, according to the report, in cutting how much federal health programs pay for medicine. Squeezing the pharmaceutical companies probably has fewer political downsides: The main disadvantage is the potential to reduce medical innovation, and the people who lose extra years of their lives because of it will never know it.
But the White House idea raises the same question as the floated notion of letting taxes rise on the highest earners: If that’s what Republicans plan to do, why are they working on a reconciliation bill at all? Both policies have more natural support from congressional Democrats than Republicans. Why give the Democrats something they like in return for nothing from them?
Trying to cut a deal that brings in some congressional Democrats would have several advantages over what they’re trying to do now. It would let Republicans in dicey districts off the hook for voting for a partisan bill. It would give negotiators more options to work through — partly by giving them more potential votes, partly by letting them make policy changes that don’t fit into reconciliation procedures. And if the Democrats aren’t reasonable in negotiations, having made the effort would put Republicans in a better position to blame them for the resulting tax increases.
The bipartisan scenario I’m mentioning would have been more plausible right after the elections than it is now. But Republicans might need to make deals with the Democrats if they can’t agree on a reconciliation bill — and they do not seem at all close to reaching the near-unanimity that would require.