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The health-care issue is what killed the Trump Republicans in the midterm elections last fall. It could well be what kills them again in 2020. The defiant U.S. President and his barking dogs on the hard right have let their obsession with terminating Obamacare erode their support.

Exit polls showed that health care was by far the most important issue in the midterms. Forty-one per cent said so. Next was immigration, far back at 23 per cent. Russian controversies have received about 20 times the media attention of health care. But your average Earthling cares far more about the functioning of their heart, lungs, legs, eyes and ears than they do about Kremlin bots.

During his 2016 campaign, Donald Trump promised to repeal and replace Obamacare. Following the election his Republicans humiliatingly bungled the mission. The midterm results wherein the Democrats took the House of Representatives should have settled the issue for Mr. Trump. Despite the many deficiencies with the Affordable Care Act, Obamacare’s official name, it’s providing health care for an estimated 20 million more Americans.

But this President doesn’t want an Obama success story remaining on the books. It sticks in his craw, so much so that he let it ruin the victory lap he should have enjoyed when the short summary of the Mueller report on Russian electoral interference was released, showing that collusion was a delusion.

Barely had the little Mueller summary appeared when Mr. Trump was railing against Obamacare, announcing his support for a lawsuit that would completely invalidate the program. To the delight of his opponents, the health-care issue took over the news cycle.

Subsequently, Senate Majority Leader Mitch McConnell made an attempt to drive some sense into the President’s head. Defying oddsmakers, he accomplished the unlikely feat. He convinced Mr. Trump that an Obamacare overhaul was not possible. He told him the Senate would not be taking up health-care reform in any comprehensive way before the 2020 election. Why would it? Any GOP bill would be defeated in the Democrat-controlled House anyway.

Mr. Trump then flip-flopped, stating there would be no new Republican health-care plan in place until after the 2020 election, presuming a victory. The upshot leaves the Democrats firmly in control of the No. 1 issue in the land. They are the health-care party.

In his missteps, Mr. Trump was guided by his fixation on what his base wants. Seventy per cent of Republicans oppose Obamacare. The base isn’t broad enough to win him an election, however, and expanding it is no easy task. It is surprising, for example, that the good initial news about the Mueller report summary didn’t move Mr. Trump’s ratings up one bit.

Complicating matters is that the President now has a hardliner, a former Tea Party guy, in Mick Mulvaney, as his chief of staff. It was Mr. Mulvaney who convinced Mr. Trump to go hard against Obamacare following the Mueller release. Even Vice-President Mike Pence, who normally cowers at the President’s every word, warned Mr. Trump against going this route.

Doug Heye, a former Republican National Committee spokesman, says the Republicans are in a fix, not knowing where to turn. “I’ve seen up close,” he tweeted, “how Republicans can’t agree on much of anything re healthcare.”

They’d better, though. Almost half of Americans still say it’s hard to pay medical bills. Deductibles for those on private coverage have risen substantially.

Democrats have divisions of their own on the issue. They realize Obamacare has to be markedly improved. The more liberal among them, comprising over 100 elected members, including several candidates for the Democratic presidential nomination, are advocating plans for full-bore, Canadian-style universal coverage.

This marks quite a shift from just a few years ago when, as proponent Bernie Sanders says, it was deemed a “wild and crazy idea.” But it would come with an enormous price tag and it would end the health-care plans of 180 million Americans whose insurance coverage comes from their private employers.

The proposal will cause divisions among Democrats as the race for the nomination progresses. House Speaker Nancy Pelosi cautioned against the ambitious scheme this week.

But debates on how to improve the progress they’ve already made on health care see the Democrats in a far more advantageous position than a Grand Old Party, which opposes the popular Obamacare, which has no idea how to replace it and which has a President beholden to his uncompromising base.

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