One last Obamacare repeal try

Posted 9/22/17

EDITOR'S NOTE: The following editorial appeared in the Monday, Sept. 18, edition of The Wall Street Journal - It was submitted by Sen. Lindsey Graham.

- "The question is whether a last-ditch effort by Sen. Graham and a few colleagues represents …

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One last Obamacare repeal try


EDITOR'S NOTE: The following editorial appeared in the Monday, Sept. 18, edition of The Wall Street Journal - It was submitted by Sen. Lindsey Graham.

Sen. Lindsey Graham admits that when a defense specialist like him feels compelled to roll out a health-care bill, something has gone wrong - and that's an understatement for the Republican failure to repeal the Affordable Care Act. The question is whether a last-ditch effort by Sen. Graham and a few colleagues represents an improvement over the Obamacare status quo. The answer is yes.

Sen. Graham and Sen. Bill Cassidy (R-La.) unveiled a bill that would start to unwind Obamacare.

The legislation repeals the individual and employer mandates and the 2.3 percent medical device tax.

The bill replaces money spent on tax credits and Medicaid expansion with block grants to states, which would allow governors to experiment with insurance reforms. Another selling point is that a rejiggered formula will divvy up federal dollars more equitably, as states such as Massachusetts and California haul in an outsize share under current law.

Block grants are certainly progress: The Obama Administration's Medicaid expansion enrolled working-age, childless adults above the poverty line, and the feds footed most of the bill to bait states to participate.

The program reimbursed at a much lower rate for the disabled and children, the traditional Medicaid population. This has resulted in some states under-covering the most vulnerable.

Graham-Cassidy is less ambitious than the Senate's Obamacare replacement that failed over the summer, and we could go on at length about its limitations. But the proposal at least takes most decision-making out of Washington and puts a spending cap on Medicaid and Obamacare. Reform-minded governors would have the chance to create showcases for insurance-market innovation.

As with past health-care failures, Republicans can only lose two members. Sen. Rand Paul (R-Ky.) is as persuadable as Chuck Schumer, and the same may be true of Sen. Susan Collins of Maine. Sen. John McCain (R-Ariz.) shot down the last repeal attempt on dubious objections about an open process. Some think Sen. Lisa Murkowski (R-Alaska) is winnable, but she seemed amenable to the last bill - until she bailed at the final hour.

Heritage Action waded in to note that earlier versions of Graham-Cassidy did not repeal all of Obamacare's taxes - as if they would vanish if Congress does nothing. Sen. Mike Lee (R-Utah) usually follows Heritage, though Sen. Lee's office said he's "encouraged" by what he's seen but has yet to make a final decision.

The question for members is: What is the alternative? The budget procedure that allows the Senate to address the law with a 51-vote majority expires on Sept. 30.

Obamacare's exchanges will continue to deteriorate, and Democrats will blame Republicans for every premium increase from here to November 2018. The law will require who knows how many patches and bailouts in coming years, and consumers will continue to face higher prices and fewer choices.

Lamar Alexander (R.-Tenn.) is trying to work a deal with Patty Murray (D-Wa.) to mitigate some of the consumer pain for next year. The idea is to swap subsidies for insurers for more state flexibility. Yet Democrats have so far been unwilling to relax the state waiver process to allow for more than de minimis changes.

The GOP's negotiating hand will not become stronger as the election approaches.

The best path forward is to pass Graham-Cassidy and improve or amend it later as necessary, or perhaps consider discrete bills to mend health- care markets. This has the added political advantage of at least fulfilling some facsimile of the "repeal and replace" promises Republicans have made to voters for seven years.

One lesson for moderate Republicans is that no dilution or revision will placate the left, which has panned Graham-Cassidy as evil and heartless sight unseen. The press is suggesting that the timeline is too quick to ram through such a consequential bill, but then the Affordable Care Act re-engineered one-sixth of the economy in the middle of the night on Christmas Eve in 2009.

The Cassidy-Graham bill appeared on the same day as a "Medicare for all" proposal from Sen. Bernie Sanders (Ind., Vt.), and don't be surprised if voters start looking to the left for solutions. Graham-Cassidy is the best remaining chance the GOP has to make incremental progress on health care before they face voters next year having to explain their failure.