Cassidy-Graham has an important, albeit fixable, flaw—what we might call “asymmetric federalism.” The core idea in the bill is to take the money Obamacare spends on expanding coverage to the uninsured and give it to state governments in the form of block grants. States, in turn, could use these block grants to address the health-care needs of their populations. It’s an attractive idea, in theory. But the bill would put a heavy Washington hand on the federalism steering wheel. It would make it relatively easy for blue states to expand the role of single-payer health care, while making it rather difficult for red states to achieve market-oriented reforms.

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Senate Republicans’ last-ditch attempt to repeal and replace Obamacare rests on the unlikely collaboration of a veteran senator who can’t stand health policy, a wonky freshman who has never passed major legislation and a former senator who lost his seat a decade ago.

Together, Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.) and former Pennsylvania Sen. Rick Santorum crafted the latest GOP repeal bill in hopes of delivering on the party’s seven-year-old campaign promise to repeal Obamacare.

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Interestingly, while trying to craft legislation that would appeal to Republican moderates in the Senate, Cassidy and Graham have created a plan that is in some ways more conservative than the earlier House and Senate repeal-and-replace bills. The Cassidy-Graham bill is comparatively simple and straightforward. It lets states run their insurance markets as they see fit. This is a welcome return to federalist principles that the GOP had forgotten when crafting their earlier ObamaCare replacement bills.

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It’s worth reading the Graham-Cassidy bill. It would repeal the individual and employer mandates of the Affordable Care Act, impose per capita caps on Medicaid, increase contributions to health-savings accounts, allow states to waive regulations on private insurance providers, and provide those states with block grants so they can design their own health-care systems.

If the bill became law, it would therefore be a genuine federalist triumph. A large portion of the federal money now set to fund the Medicaid expansion and subsidies of the Affordable Care Act would be instead distributed to individual states. Each state would have the freedom and means to develop its own health-care system. Reasonable people disagree over how best to design a health-care system, and under Graham-Cassidy, their ideas could be tested without causing a nationwide catastrophe and the disruption of a vital service.
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Senate Republicans’ last-gasp Obamacare repeal effort is gaining steam, with key senators who tanked the last push in July signaling new openness to the latest attempt and GOP leaders growing increasingly bullish.

While the proposal written by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) remains short of 50 votes, it also has just one hard “no” vote, from Kentucky Sen. Rand Paul, and another expected “no” in Sen. Susan Collins of Maine. Three “no” votes would kill the bill, but in an encouraging sign for repeal proponents, no one is stepping forward yet to deliver that final nail.

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Unless Republicans can agree by Sept. 30, they won’t be able to pass a bill without 60 Senate votes. Here’s a wild idea: Instead of repealing ObamaCare, make it unconstitutional. Recall how the Supreme Court split when it upheld ObamaCare in 2012. What broke the tie was a novel opinion by Chief Justice John Roberts, who upheld the law’s individual mandate by declaring it a tax. The GOP can take advantage of that premise and pass a two-page bill clarifying that Congress did not intend to use its taxing power to enforce the individual mandate and disavows the same going forward. Congress could state that it intends ObamaCare to contain no severability provision—meaning that, as the four dissenting justices agreed in 2012, the entire law must fall if the mandate is unconstitutional.

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Like the Better Care Reconciliation Act, Graham-Cassidy would repeal Obamacare’s individual and employer mandates. Both bills increase annual contributions to health savings accounts. Both bills phase down state-based Medicaid provider taxes that states use to game the federal government into giving them more money than they’re supposed to get. Both bills allow states the ability to frequently cull their Medicaid rolls of ineligible recipients—something they can’t do today.

The bill would institute a per-capita allotment for the legacy Medicaid program that is quite similar to the one in the BCRA. This per-capita approach is essential to ensuring that Medicaid is fiscally sustainable in the future. Both bills allow states to institute work requirements for Medicaid.

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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. 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.
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Two Republican senators are launching yet another attempt at repealing Obamacare, preparing to offer legislation that would try to bridge one of the key dividing elements of an effort that has twice failed to pass the senate, according to a section-by-section analysis obtained by NBC News.

It’s too early to gauge whether or not the approach could muster enough support to pass either the Senate or the House, or even if GOP leadership would take it up, but it’s a last-ditch effort by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., to repeal the Affordable Care Act.

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Ohio Gov. John Kasich on Friday said that some of the essential health benefits that had been set up under Obamacare were too limiting to customers, proposing that someone have the option to buy a plan that excludes maternity coverage while explaining his decision to mandate autism coverage in his state.

Kasich, a Republican, was appearing in a panel in Washington alongside Colorado Gov. John Hickenlooper, a Democrat with whom he has been working on an Obamacare stabilization plan to lower the costs of premiums and give customers more choices for health insurance plans.

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