Competition of Ideas

On September 26, repeal and replacement of Obamacare sputtered to an end as four GOP senators indicated they would not support the Graham-Cassidy Bill.

For the last seven years, Republicans promised to repeal Obamacare yet when it came to making the change they couldn’t do it.  They choked and took a knee.

The bill by Senator Graham and Senator Cassidy would have eliminated some of Obamacare’s most unpopular provisions, according to Lanhee Chen of the Hoover Institution, by enacting reforms that would lower costs, expand choices, promote fiscal responsibility and give power back to the states and consumers.

The Graham-Cassidy bill’s biggest strength is the idea that states are uniquely equipped to design and implement heath care programs that suit their residents.  The bill would consolidate much of the federal funding given to states under Obamacare by helping to address the dramatic state inequities that Obamacare optional Medicaid expansion created in federal healthcare finding.

According to the bill’s authors, in 2016 the federal government sent states anywhere from about $400 in Mississippi to over $10,000 in Massachusetts per beneficiary whose annual income was between 50 percent and 138 percent of the federal poverty level.  Graham-Cassidy would have equalized the base per-person amount the government gives to the states.  By 2026, it would be about $4,400 for each qualified beneficiary.

These block grants of money would give states significant latitude to institute reforms.  Some states might want to continue Obamacare’s regulatory provisions.  Others might create reinsurance pools to help provide affordable coverage to people with pre-existing conditions.  Regulatory requirement could be lessened to encourage greater competition and lower premiums.

What Graham-Cassidy hoped to create was a “competition of ideas” by emulating good ideas and discarding the bad ones.

The bill would create financial incentives for states to improve the quality of care provided through Medicaid and it would leave in place Obamacare’s protections for patients with pre-existing conditions. And lastly, the bill would have met what the Republicans had promised for seven years to repeal and replace Obamacare.

Now, thanks to the poor leadership of Senate Majority Leader Mitch McConnell and the duplicity of Senators John McCain, Rand Paul, Lisa Murkowski and Susan Collins, the Affordable Care Act lives on.  GOP leaders now face the challenge of explaining to voters their failure to repeal after seven years of promising to do so.

Passage of the Graham-Cassidy bill would have also cleared the way to ending the individual and employer mandates, repealing the Medical Device Tax and phasing out the Obamacare exchanges.

Senator John McCain, who was a strong opponent of Obamacare and was re-elected last year based on his promise to repeal, stated he wanted first to check with his governor.  Arizona Governor Doug Ducey responded by endorsing the bill.  McCain then changed his mind out of contempt for President Trump.  Senator Rand Paul who voted for the “skinny” Obamacare repeal now says Graham-Cassidy does not go far enough on repealing all of Obamacare.  Senators Murkowski and Collins worry about cuts to Medicaid.

All four senators – who will not be on the ballot next year – may have guaranteed through their actions the The Affordable Care Act endures permanently.  Republicans across the country deserve better than what they get from their elected representatives – especially these weak Senators.