BILL KILLER: Rand Paul’s do-or-die health care demands.

Cut the Affordable Care Act spending way back. He says that “only a significant reassessment of this trillion-dollar spending regime would get my support.” The problem with this demand is that if you have deep cuts in health care spending you will push away other moderate Republicans, and not just Collins and Alaska’s Lisa Murkowski.

Scrap way more Affordable Care Act regulations. He says that states should “have to opt into ACA regulations,” rather than having to opt out. The problem with this demand is that it only appeals to conservatives. You’d get Ted Cruz on board but still lose other moderate Republicans.

Expand association health plans, which would let small businesses and individuals band together to buy health insurance. The problem with this demand is that Republican leaders have already determined they can’t do this through the budget reconciliation rules.

Baby steps, Senator.