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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A crucial GOP senator says that after weeks of effort, there’s not enough agreement among lawmakers to advance a small package of bipartisan changes that would stabilize Obamacare’s health insurance markets. “We have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted,” said Senator Lamar Alexander, the Tennessee Republican who leads the Health, Education, Labor and Pensions committee.
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The Centers for Medicare and Medicaid Services has a powerful tool for improving quality and reducing costs: the Center for Medicare and Medicaid Innovation. Congress created the Innovation Center in 2010 to test new approaches or “models” to pay for and deliver health care. The complexity of many of the current models might have encouraged consolidation within the health care system, leading to fewer choices for patients. The Trump administration is analyzing all Innovation Center models to determine what is working and should continue, and what isn’t and shouldn’t. Strengthening Medicare and Medicaid will require health care providers to compete for patients in a free and dynamic market, creating incentives to increase quality and reduce costs.
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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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