The Republicans’ Latest Epiphany: Punt

The Gra­ham-Cas­sidy bill, so named be­cause it was primar­ily au­thored by Sen­at­ors Lind­say Gra­ham (Re­pub­lic­an, South Car­o­lina) and Bill Cas­sidy (Re­pub­lic­an, Louisi­ana), is the latest at­tempt on the part of the Re­pub­lic­an Party to “re­peal and re­place” the Af­ford­able Care Act, also known as Obama­care. The lynch­pin of this latest plan is something that un­doubtedly seemed like a mas­ter­stroke to Sen­at­ors Gra­ham and Cas­sidy: the plan del­eg­ates al­most everything health­care re­lated to the states.

Why would Re­pub­lic­ans grav­it­ate to such a plan? Sev­er­al reas­ons. First, it feels ideo­lo­gic­ally pure to Re­pub­lic­ans. Al­though they rarely gov­ern this way in prac­tice, Re­pub­lic­ans of­ten tout their be­lief that the states gov­ern bet­ter than the Fed­er­al gov­ern­ment.1 Second, it lets them keep their prom­ise to their base to re­peal Obama­care while de­flect­ing re­spons­ib­il­ity for do­ing so. Obama­care is now mostly viewed fa­vor­ably by Amer­ic­ans while GOP ef­forts to re­peal it are deeply un­pop­u­lar. Nev­er­the­less, re­peal­ing Obama­care re­mains a high pri­or­ity for the Re­pub­lic­an base and donors. Fi­nally, it al­le­vi­ates the need for Con­gres­sion­al Re­pub­lic­ans to work out the de­tails be­fore their win­dow for passing a bill through the Sen­ate with only 51 votes closes on Septem­ber 30.2

Of course, all of this is non­sense. The states gen­er­ally don’t gov­ern all that well and have only rarely ac­ted as the “labor­at­or­ies of demo­cracy” that Re­pub­lic­ans so of­ten talk about. In fact, most state le­gis­latures are part time, leav­ing state le­gis­lat­ors pre­cious little time to ad­equate study and de­bate a top­ic as com­plex as health care.3 The states had years to en­act health care le­gis­la­tion be­fore the Af­ford­able Care Act passed and only one ever did: Mas­sachu­setts.

Most im­port­antly, any­one who tells you that this bill will in­crease cov­er­age, de­crease premi­ums, or pro­tect people who have pre-ex­ist­ing con­di­tions is ly­ing. This bill turns all of those de­cisions over to the states and many states will not be up to the chal­lenge. And oddly enough, once again, it’s a comedi­an who is the voice of reas­on in this de­bate:


  1. “I be­lieve in state’s rights;” was the key phrase in a con­tro­ver­sial speech Ron­ald Re­agan gave at the Neshoba County Fair in 1980

  2. Nor­mally, le­gis­la­tion in the Sen­ate is sub­ject to the fili­buster. Any Sen­at­or can, un­der the stand­ing rules of the Sen­ate, pro­long de­bate on any meas­ure in­def­in­itely and when that hap­pens, a ⅗ ma­jor­ity (60 votes) is re­quired to end de­bate and pro­ceed to a vote. But the Sen­ate has a spe­cial fili­buster-proof pro­cess for budget bills called re­con­cili­ation and earli­er this year a bill passed that qual­i­fied the health­care re­peal ef­forts for the re­con­cili­ation pro­cess. But the Sen­ate par­lia­ment­ari­an has ruled that that qual­i­fic­a­tion ends with the cur­rent fisc­al year, on Septem­ber 30. 

  3. Utah’s le­gis­lature, for ex­ample, meets for only 45 days a year. Ima­ging try­ing to pass a true health care bill at same time you are con­sid­er­ing hun­dreds of oth­er bills in only 45 days!