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