Kiichiro Sato / AP

President Trump's threat to withhold Affordable Care Act payments to insurers shows how he thinks of health care: Everything is negotiable, like it is in a real estate deal. In this case, it's his bargaining chip to get Democrats to negotiate on an ACA replacement plan. But in reality, it could panic insurers and crash the marketplaces.

The president doesn't have strong convictions himself about future directions for health care. But health policy is not like real estate. The partisan divide in health policy is grounded in deeply felt differences on both sides over policy and principle. It's hard to see Trump's approach to deal making working very often in health.

This was why Trump couldn't force a deal with the Freedom Caucus to pass the American Health Care Act in the House; the bill was not conservative enough for the caucus, and in their eyes, it violated their principles and political promises they had made. It is also why using Obamacare's marketplace cost sharing subsidies as a bargaining chip to try to force the Democrats to the table is unlikely to work.

Play that one out for a moment:

  • The subsidies are withheld, or a decision is delayed to the point where insurance companies withdraw.
  • The marketplaces collapse or falter in many states.
  • Some moderate Democrats want to come to the table to rescue the millions who would lose coverage, most likely in the Senate.
  • The right adds their demands as a condition of coming to the table. So does the left.
  • Negotiations quickly snowball, and the entire ACA is opened up for debate once again.
  • Stalemate follows.

There are other reasons why Democrats may not accede to Trump's threat on marketplace subsidies. They may calculate, for example, that the administration will own the fallout for a collapse in the marketplaces, as polls are starting to suggest they will.

Lawmakers are also hard to threaten because most come from safe political districts, as a recent Cook report featured in Axios showed, and they have been getting safer and more polarized.

So, Art of the Deal, meet health care. Whether it's bringing moderate Republicans together with conservatives ones, or Democrats together with Republicans, dealmaking in health care requires the hard, roll-up-your-sleeves work of developing policies that will bridge the partisan and ideological divide.

Go deeper

Dion Rabouin, author of Markets
1 hour ago - Economy & Business

Wall Street fears meltdown over election and Supreme Court

Illustration: Aïda Amer/Axios

The death of Justice Ruth Bader Ginsburg and President Trump's vow to name her replacement to the Supreme Court before November's election are amplifying Wall Street's worries about major volatility and market losses ahead of and even after the election.

The big picture: The 2020 election is the most expensive event risk on record, per Bloomberg — with insurance bets on implied volatility six times their normal level, according to JPMorgan analysts. And it could take days or even weeks to count the record number of mail-in ballots and declare a winner.

Election clues county by county

Ipsos and the University of Virginia's Center for Politics are out with an interactive U.S. map that goes down to the county level to track changes in public sentiment that could decide the presidential election.

How it works: The 2020 Political Atlas tracks President Trump's approval ratings, interest around the coronavirus, what's dominating social media and other measures, with polling updated daily — enhancing UVA's "Crystal Ball."

Updated 4 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 3 a.m. ET: 31,605,656 — Total deaths: 970,934 Total recoveries: 21,747,491Map.
  2. U.S.: Total confirmed cases as of 3 a.m. ET: 6,897,432 — Total deaths: 200,814 — Total recoveries: 2,646,959 — Total tests: 96,612,436Map.
  3. Health: The U.S. reaches 200,000 coronavirus deaths — The CDC's crumbling reputation — America turns against coronavirus vaccine.
  4. Politics: Elected officials are failing us on much-needed stimulus.
  5. Business: Two-thirds of business leaders think pandemic will lead to permanent changes — Fed chair warns economy will feel the weight of expired stimulus.
  6. Sports: NFL fines maskless coaches.

Get Axios AM in your inbox

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Subscription failed
Thank you for subscribing!