Democrats pen letter to Trump on working together for health care reform. What can they achieve?

As Republicans led by Speaker of the House Paul Ryan gear up for a second swing at health care reform, Democratic senators say they’re willing to work with the president – if he stops attacking their party’s landmark health care law.

In a letter signed by 44 of the Senate’s 48 Democrats, the bulk of the party calls on President Trump to rescind his efforts to completely abolish the Affordable Care Act, the legislation, known as Obamacare, passed in 2010. The call comes as Democrats are emboldened by the defeat of the Republican-backed reform effort, which was pulled from the House floor last Friday after Republicans failed to come to a consensus.

“Members of the Democratic caucus remain ready and willing to work with you on policies that would improve the stability of the individual insurance market,” the senators write in the letter, which was shared with The Washington Post. “We ask that you begin the work of improving health care for millions of Americans by rescinding your January 20th executive order.”

“Your administration must commit to putting an end to all efforts to unravel the ACA, undermine the health care system, increase costs, or hurt patients, providers and families,” they continue.

But Mr. Trump spent months campaigning on a promise to repeal and replace his predecessor’s legislation, and a small, conservative faction of the House GOP along with as many as 25 moderate members won’t compromise for anything less. While Trump could make incremental, administrative adjustments to the law on his own, it’s unlikely he could achieve the necessary Republican support for new measures without completely doing away with the existing law, says Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health.

These constraints will likely halt any overhaul efforts.

“I can see if the president has a reason of wanting to make some administrative agreements to stabilize the existing law, but I don’t see that happening prior the 2018 election, which could decide things. The House and Senate could change, and that would make it very different,” Dr. Blendon tells The Christian Science Monitor in a phone interview Wednesday.

But Democrats could use this as a chance to position themselves and their party’s platform for that election, when the Senate will see 23 Democratic and two independent seats up for re-election.

“It is a position that makes sense for them running in the 2018 election: They’re making an offer to the president to [compromise],” he adds. “But that will not occur if the Republicans are the majority party.”

Rep. Ryan (R) of Wisconsin said Monday he planned to continue pushing for an overhaul of the system, despite Mr. Trump’s promise to let the health care law “explode” before drafting a new one.

“While we would welcome your sincere interest in bipartisan work to improve quality, lower costs, and expand coverage, we are concerned by your recent statement indicating it would be a good thing to make the ACA ‘explode,'” the Democrats’ letter said. “Instead, we urge you to use your executive authority to support a stable, competitive insurance marketplace.”

House Minority Leader Nancy Pelosi of California said earlier this week that the party could find common ground with the president on measures such as lowering the costs of prescription drugs and refining individual insurance marketplaces, two things Trump has supported.

While repealing and replacing the legislation was a hot topic on the campaign trail, post-election polls have shown that most Americans want to see the law kept in place with adjustments, including expansions, rather than completely repealed.

“It’s at this point a political strategy more than a policy strategy,” Mark Peterson, chair and professor of the University of California, Los Angeles Luskin Department of Public Policy whose research focuses on interactions between Congress, the president, and interest groups in policy making, tells the Monitor. “For President Trump to accept this invitation would, number one, mean that he would have to declare that he wasn’t going to do something that he made big promises about. And two, he’d have to work up a coalition built almost entirely around Democrats and some moderate Republicans.”

Still, not all Democrats see publicly defending the law as a smart campaign strategy.

The four senators who did not sign the letter include Joe Manchin of West Virginia, Heidi Heitkamp of North Dakota, Jon Tester of Montana, and Angus King (I) of Maine, according to the Post. They first three are all up for re-election in red states.

Meanwhile, Ryan plans to keep moving forward, and has said he would unveil a new plan on Thursday or Friday while meeting with donors in Florida.

“I will lay out the path forward on health care and all the rest of the agenda,” Ryan said in the call Monday, according to a recording obtained by the Post. “I will explain how it all still works, and how we’re still moving forward on health care with other ideas and plans. So please make sure that if you can come, you come – it will be good to look at what can feasibly get done and where things currently stand. But know this: We are not giving up.”

And now is still their window. Dr. Peterson says it’s likely Republicans will lose some seats, noting that since 1934 the House’s makeup has shifted all but two times under new presidents. After that, it could be even harder for them to pass the changes they've talked about.

Democrats “should be spending this time doing what the Republicans did not do when they were facing Obama,” he adds. “That is to come up with a proposed legislative plan for improving and strengthening the Affordable Care Act.”

That way, when the next election cycle rolls around, they can say, “here’s what we would do, we’re laying it out there, we’ve offered this to the president,” Peterson says.