Majority Leader Mitch McConnell vows to bring the Lindsey Graham-Bill Cassidy sponsored Obamacare repeal to the Senate floor next week.
This represents the last, best chance to repeal Obamacare. Take those two words — last, best — literally.
The deadline for reconciliation occurs a week from Saturday. This means anything that passes after that point falls under the normal Senate rules, which include the requirement of sixty votes to invoke cloture. To quote Elvis, “It’s now or never.”
By “best,” Graham-Cassidy represents a significant improvement upon recent repeal-and-replace bills floated and voted upon in both the House and the Senate. It relieves insurers from onerous stipulations within Obamacare, eliminates counterproductive taxes on medical items, and permits states to pursue the desires of their citizens through block grants.
Graham-Cassidy, the brainchild in part of former Senator Rick Santorum, most radically deviates from the status quo by block-granting Medicaid funds to the states. As the chief sponsors of the bill point out, 37 percent of Obamacare funds go to Massachusetts, Maryland, New York, and California. Graham-Cassidy aims for more equity and less favoritism. By allocating $171 billion a year for the next seven years, it represents a cut from current plans. The block grants allow for creativity, something desperately needed in a country that spends nearly one of every five dollars in the economy on health-related expenses.
The bill spells out one such area with room for flexibility: “a State may elect to condition medical assistance to a nondisabled, non-elderly, nonpregnant individual under this title upon such an individual’s satisfaction of a work requirement.”
It repeals taxes on over-the-counter medications, health savings accounts, and medical devices. How an Affordable Care Act could act to make care more affordable by taxing it never quite made sense to anyone with sense.
Graham-Cassidy increases the amount Americans can contribute to medical savings accounts. This benefits the government by individuals’ relying on their wealth to pay for their care and benefits the individuals by allowing them to shield more of their earnings from the government. And when people spend their money on a good, it helps the common good. We shop for deals and avoid waste when our dime and not the dole pays for it.
Waiving community rating, which prohibits providers from varying rates based on varying behaviors, essential health benefits, which requires insurers to cover benefits not everyone finds essential or even beneficial, and guaranteed issue, which forces insurers to offer the same plans to everyone regardless of preexisting conditions, all serve to bring down the cost of health care dramatically. Obviously, a small number of people benefiting from others subsidizing their unhealthy behaviors or desire for birth control, psychiatrist visits, or other “essential” benefits may pay more under Graham-Cassidy. But the rest of us who pay for them under Obamacare, pay less.
The bill does not strike as a straight repeal of Obamacare. And Republican critics dutifully note this.
“This bill keeps 90 percent of the spending of Obamacare and reshuffles it,” Kentucky Senator Rand Paul explained earlier this week. “Really, when you look at how it reshuffles it, it does it just to take money from the Democrat states and give it to Republican states.”
If the goods are a bit odd, the odds are a bit good. One of the strangest aspects of the Trump presidency remains how some of his internecine enemies turn out to become the president’s best friends. Trump owes the greatest success of his presidency, the elevation of Neil Gorsuch, to 2016 legislative maneuvering by Mitch McConnell. Should Graham-Cassidy triumph, Trump owes a thank-you call to the man whose cell number he publicly disseminated on the campaign trail last year.
Graham-Cassidy is not ideal. But it’s not Obamacare, either. And with eight days to realistically replace the Affordable Care and Patient Protection Act, it represents the last and best hope for Americans eager to escape from under the weight of ever-rising premiums and hospital bills.
Hunt Lawrence is a New York-based investor. Daniel Flynn is the author of five books.