the Beacon Journal editorial board

What would have shaken up Washington? President Trump would have issued a different ultimatum than the one he put forth on Thursday evening as his fellow Republicans struggled with their pledge to repeal and replace the Affordable Care Act. The president would have declared from the start that Republicans and Democrats join him in repairing the flaws in the landmark health care law.

Such a stand would have followed some of his positions during and since the campaign, about coverage for “everybody,” a “terrific” alternative, about protecting Medicaid. Instead, the president pushed for — and then walked away from — a final vote on the House floor, after seeking to woo enough Republicans to support the ill-conceived measure crafted by Speaker Paul Ryan and backed by the White House.

In the end, House Republicans achieved neither repeal nor replace.

As many analysts noted, the presidential case wasn’t about the policy advances for the country. He focused on the political angles, warning that in 2018 he would campaign against Republicans who failed to vote for the bill.

There’s nothing wrong with playing hardball. The unfortunate thing has been the content of the House bill. All of the negotiating among Republicans did not make it better. The Congressional Budget Office found it still would result in 24 million losing their health insurance during the next decade. That’s what happens when you reduce subsidies and narrow coverage.

To bring along Republicans worried about such shrinkage, the president and speaker restored some subsidies. At the same time, in an appeal to conservatives, they reduced the “essential benefits,” which include mental health care, wellness visits, maternity and newborn care. Weigh the one change against the other, and, arguably, the latest bill was worse, the health care system slipping back, coverage much too expensive and delivering too little, many without insurance and vulnerable to financial disaster.

What House Republicans essentially proposed is an $880 billion reduction in Medicaid (the expansion eliminated), slashing in half subsidies that help with premiums, the end of assistance for high deductibles, a $600 billion tax cut (largely for the upper income rungs) and a less financially secure Medicare. Recall that roughly 30 million children are covered through Medicaid. Note what the Urban Institute projects: For households with annual incomes of $200,000 and above, the House Republican approach results in a nearly $6,000 average gain.

Those with incomes of $50,000 and below? An average loss, reaching $1,400 for incomes below $10,000 per year.

No wonder John Kasich and several other Republican governors are unhappy with the work of House Republicans, not to mention the skittishness of Rob Portman and a dozen other Republicans in the Senate. A recent Quinnipiac survey found that just 17 percent of Americans support the House bill.

The president tweeted last week that the Affordable Care Act brought “higher costs & fewer options.” Not so. Overall cost increases have slowed in health care since its enactment. The additional 20 million with coverage confirm the expanded options. What the law needs is precise repair work, or what House Republicans and the White House have failed to deliver.