Graham-Cassidy and Conservative Health Reform

In its February budget submission to Congress, the Trump administration endorsed legislation “modeled after” the bill Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) introduced last year, which would devolve much of Obamacare’s entitlement spending to the states.

The budget claims this legislation “would allow states to use the block grant for a variety of approaches in order to help their citizens.” But based on the most recent public version, the Graham-Cassidy bill needs significant changes to deliver true flexibility to states.

The administration endorsed Graham-Cassidy because it believes the legislation would give states flexibility to embrace a “variety of approaches” to health care and health insurance. But would the most recent version of the bill allow Idaho to implement its reforms without federal intrusion? In a word, no.

In at least two respects, Idaho’s plan violates the many federal requirements that would remain intact under Graham-Cassidy. Idaho’s proposal to allow annual limits of over $1,000,000, and its proposal to allow surcharges of up to 50 percent for individuals who do not maintain continuous coverage, both contravene the Washington-imposed regulatory apparatus Graham-Cassidy retains.

This raises an obvious question: If the only state-based insurance reform plan proposed to date violates Graham-Cassidy, then how much “flexibility” does the legislation really provide? To paraphrase Margaret Thatcher, conservatives have not spent the past eight years fighting to roll back a Washington-based, regulatory leviathan imposed by a Democratic Congress, only to see that leviathan reimposed by a Republican one.

To its credit, the Trump administration has worked to roll back Obamacare’s regulatory regime. Consistent with its promise in the budget to generate “relie[f] from many of [Obamacare’s] insurance rules and pricing restrictions,” the administration has proposed rules allowing greater access to short-term insurance coverage and association health plans, both of which are exempt from some or all of the Obamacare statutory restrictions.

But make no mistake: While these actions will give some individuals freedom from Obamacare’s restrictions, they will not give states the control they deserve over their own insurance markets. To give the states the freedom that the Trump administration promised, Congress must repeal the federally imposed regulatory superstructure Obamacare created. Only by doing so will Washington give states the true flexibility to explore alternative visions of health care for their citizens—Graham-Cassidy’s stated goal.

If Congress does not act to give states freedom, a future Democratic administration will reimpose each and every health care regulation the Trump administration loosened—and many more besides. The Center for American Progress made as much crystal-clear recently, when in releasing the Left’s next plan for (more) government-run health care, it proposed legislation that would “leave little to no discretion to the Administration [of the day] on policy matters.”

To the Left, Obamacare isn’t about power so much as control. As President Reagan famously stated, the “little intellectual elite in a far-distant capital” think they can “plan our lives for us better than we can plan them ourselves.” To liberals’ unquenchable desire to arrogate more power in Washington, conservatives must respond with freedom—freedom for states, and ultimately to businesses and individuals, to buy the coverage they want, and innovate in ways that can lower health spending.

The Graham-Cassidy bill has other flaws. It retains most of Obamacare’s spending (albeit disbursed to the states through the block grant) and all of its major tax increases. But at its core, the debate over health care remains one of control: Whether Washington will try to micromanage 50 states and more than 300 million people, or whether states and citizens can lead the way. We stand with the people—and hope that, after eight years of promises, the Republican Congress finally does likewise.

This post, co-written with former Sen. Jim DeMint, was originally published at The Federalist.