Pressure: Trump to campaign for GOP health-care bill in Rand Paul's home state of Kentucky next Monday

Pence was in Louisville on Saturday to fire a shot across Paul’s bow. Now here comes the man in charge.

It’s been fun lately watching Paul try to stay on Trump’s good side while he conducts a media blitz aimed at tanking the bill. On Friday, he made a point of contrasting Trump’s openness to negotiation with Ryan’s “it’s this or nothing” approach, and accused Ryan of misleading Trump about how much support the House bill really has. Yesterday he even went to bat for Trump on wiretapping, claiming that it’s quite possible that Trump’s campaign staff was the victim of “reverse targeting” by the DOJ. (“Reverse targeting” is when the you wiretap foreigners in the hope/expectation of picking up communications with a particular American.) It may be that this is a legislative strategy by Paul, designed to pry Trump away from backing the House bill by convincing him that he, not Ryan, is his true ally in all of this. But as a matter of basic retail politics, he’s also surely trying to ingratiate himself to Trump well enough that Trump won’t treat him as an out-and-out enemy in selling the bill in Kentucky. It’s a reprise of the 2015 Ted Cruz approach to Trump: Their goals conflict for now, guaranteeing a confrontation eventually if nothing changes, but the nicer Paul is to him, the longer that confrontation can be delayed — and hopefully avoided, if Trump ends up turning on Ryan and abandoning the current bill.

When push comes to shove, though, Paul has little to worry about. He’s not up for reelection again until 2022. And with data like this circulating, Kentucky voters will think twice before backing Trump against Rand:

The older, more downscale, and rural you are, the more likely you are to take it on the chin from TrumpCare. In fact, according to the Marsh & McLennan analysis cited by the Journal, of the 100 counties where a 62-year-old earning $36,000 a year would see the biggest jump in health-care costs under the GOP bill, 97 are rural — Trump’s bread and butter. Whether Paul’s more conservative approach to reform would make things even worse for poorer Americans is unclear, but that’s the virtue of being in the opposition — Paul doesn’t need to worry about selling his own bill, merely opposing a bill that won’t play well with his home state’s electorate once they begin digesting the numbers. That’s what the “denounce and preserve” approach to ObamaCare is all about.

With Trump and Pence visiting Paul’s backyard to make the case for the House bill, the Guardian decided to visit Pence’s backyard and ask rural Hoosiers how they like the GOP proposal. Replacing ObamaCare sounds good to many, but rolling back the Medicaid expansion is a different story:

Though Phelps said she would support Trump even if it passed, she is upset by the idea of Medicaid cuts.

“For Medicaid to say, ‘We’re going to spend X amount of dollars on you, and that’s all we’re going to spend’ – we’re supposed to just roll over and die because we can’t pay it ourselves?” she said. “X-rays, and MRIs, and CT scans, surgeries and stuff – we have no control over how much that is … I would not be able to pay that out of my pocket, and I have to pay that to live … to put a cap on it is uncalled for.”…

[H]ere, in a rural corner of Indiana where Trump won 40,000 votes to comfortably beat Hillary Clinton by 10,000, many low-income people are covered by a program Pence put in place only two years ago and which Republican proposals would severely cut.

Pence’s program, called HIP 2.0, is part of Medicaid. It is funded by the ACA, the law that Pence continues to lobby against. Including Medicaid, more than one in three people use government health coverage in Indiana.

How’s the bill going to poll once CBO scores it and Democrats go to work in red counties with ads touting the Medicaid cuts? We’ll know soon.

Here’s Paul making the case against the bill yesterday and not backing down in claiming the bill won’t pass the Senate. Note his comments about paying for Medicaid with money we don’t have. One thing to watch for next week: Will Trump overtly threaten to help someone primary Paul if he doesn’t back the bill? According to the Examiner, he warned Republicans last week that he might do that for recalcitrant House members. Paul won’t fret about being threatened since he’s six years away from needing to worry about it (Trump might not even be president in 2022!) but scaring Paul isn’t the point. Threatening to primary him next week would be a way to scare more vulnerable Republicans. I doubt Trump will go nuclear as soon as Monday, but stay tuned.