Daily Archives: September 22, 2017

Democrats once liked a federalist solution to health care, and Sen. Lindsey Graham was one of those who worked with them. In 2007 he and Wisconsin Democrat Russ Feingold proposed the State-Based Health Reform Act that would have given states even more freedom than Graham-Cassidy. But these days Democrats fear that state laboratories would discredit the command and control approach to health care that they hope will lead to single-payer. The choice Republicans face isn’t between Graham-Cassidy or some bipartisan beau ideal. Their choice is to pass their own bill, which now means Graham-Cassidy, or fail again and cede the health-care advantage to the single-payer wing of the Democratic Party.

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Based on estimates, overall federal funding for coverage expansions and Medicaid would be $160 billion less than current law under the Graham-Cassidy bill over the period 2020-2026. Thirty-five states plus the District of Columbia would face a loss of funding. Federal funding under the new block grants would be $107 billion less than what the federal government would have spent over the period 2020-2026 for ACA coverage. A typical Medicaid expansion state would see an 11% reduction in federal funds for coverage compared to an increase of 12% in a typical non-expansion state.

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Two GOP senators are likely “no” votes: Kentucky’s Rand Paul and Maine’s Susan Collins. But Arizona’s John McCain, who spoiled this summer’s attempt at ObamaCare repeal, seems unlikely to repeat his performance and sandbag his good friend Lindsey Graham. That means the 50th vote will come down to Alaska’s Lisa Murkowski, who says she’s still trying to decide how the bill will affect her state. If Ms. Murkowski is honest with her constituents—and about her numbers—Alaska needs a “yes” vote.

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As the Graham-Cassidy (Heller-Johnson) health care bill appears to achieve a rapid intensification of support, so too have lies and exaggerations about its contents. Some people are very mistrustful about the states’ willingness and ability to provide a regulatory environment in which broad segments of society will have decent health care. The competency and motivation of the states needs to be compared not to some fantasy federal government with unlimited resources, constant benevolence and technical competence, but to a federal government that in fact is deeply in debt and that has proven itself inept at creating stable health insurance markets.

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