After promising to repeal and replace the Affordable Care Act for seven years, the Republicans are being offered another chance.
Usually associated with foreign affairs, Senator Lindsey Graham, Republican from South Carolina, has stepped forward with the GOP's latest health-care bill.
If the GOP isn't able to pass this one, the push for the once-unthinkable single-payer system could gain some momentum. But how good is Graham-Cassidy, as the new health-care bill is called?
A leading health-care expert, Yuval Levin, says it is the "most coherent" of the GOP plans put forward his year:
"I think it’s probably the most coherent of the proposals Republicans have looked at this year," Levin told The Weekly Standard in an email. "It does much less than some—keeping essentially all of Obamacare’s spending and taxes, for instance—but it does one big thing: it moves the bulk of the resources and a fair bit of the power of regulation to the hands of the states. That’s not a solution to Obamacare’s problems, but it is an improvement over the status quo. Combined with significant Medicaid reforms it makes for a bill that on net is worth voting for."
The key to the bill, as the Wall Street Journal explains, is block granting money to the states:
The legislation repeals the individual and employer mandates and the 2.3% medical device tax. The bill replaces money spent on tax credits and Medicaid expansion with block grants to states, which would allow Governors to experiment with insurance reforms. Another selling point is that a rejiggered formula will divvy up federal dollars more equitably, as states such as Massachusetts and California haul in an outsize share under current law.
Block grants are certainly progress: The Obama Administration’s Medicaid expansion enrolled working-age, childless adults above the poverty line, and the feds footed most of the bill to bait states to participate. The program reimbursed at a much lower rate for the disabled and children, the traditional Medicaid population. This has resulted in some states under-covering the most vulnerable.
Graham-Cassidy is less ambitious than the Senate’s ObamaCare replacement that failed over the summer, and we could go on at length about its limitations. But the proposal at least takes most decision-making out of Washington and puts a spending cap on Medicaid and ObamaCare. Reform-minded Governors would have the chance to create showcases for insurance-market innovation.
As with previous GOP attempts, the bill can only afford to lose two Republican votes, and thus it is by no means a sure thing:
Heritage Action waded in to note that earlier versions of Graham-Cassidy did not repeal all of ObamaCare’s taxes—as if they would vanish if Congress does nothing. Sen. Mike Lee (R., Utah) usually follows Heritage, though Sen. Lee’s office said he’s “encouraged” by what he’s seen but has yet to make a final decision.
The question for Members is: What is the alternative? The budget procedure that allows the Senate to address the law with a 51-vote majority expires on Sept. 30. ObamaCare’s exchanges will continue to deteriorate, and Democrats will blame Republicans for every premium increase from here to November 2018. The law will require who knows how many patches and bailouts in coming years, and consumers will continue to face higher prices and fewer choices.
The Journal notes that, if this fails, an increasing number of people might be willing to consider single-payer as the solution.