The Graham-Cassidy health-care bill is the ‘last, best hope’ this year to replace Obamacare.
The last train is leaving Reconciliation Station.
Republican efforts to repeal and replace Obamacare — derailed just weeks ago — now seem back on track. GOP senators Lindsey Graham of South Carolina, Bill Cassidy M.D., of Louisiana, Dean Heller of Nevada, and Ron Johnson of Wisconsin seek 47 more votes (including, if necessary, that of Vice President Mike Pence, to break a 50–50 tie) to pass their legislation within the Senate’s filibuster-proof reconciliation window. It closes September 30. Having snored through August, Republicans are scrambling to keep the repeal/replacement pledges that secured them the House, Senate, and White House.
The GCHJ bill would convert Obamacare from an imploding, top-down, Washington-centric, mandate-entangled madhouse into something promising: federal dollars that governors and legislators could use to finance bespoke solutions that fit each state’s priorities. While hardly the stuff of Adam Smith, this reflects the Founding Fathers’ locally oriented federalist vision. Though still a government program, GCHJ would end Obamacare’s individual and employer mandates, kill the absurd and cruel medical-device tax, and let states reject Obamacare’s “essential health benefits.” These surreal rules force teetotalers on Obamacare to purchase alcoholism-treatment coverage. Likewise, childless Obamacare policy holders must carry pediatric vision and dental benefits for boys and girls who do not exist. Why not require gay men on Obamacare to buy vasectomy insurance? GCHJ would let states rescue their residents from such expensive and indefensible Obamite nonsense.
The reliably pro-market Senator Johnson’s co-sponsorship should ease worries that GCHJ is just “Obamacare Lite,” as Senator Rand Paul (R., Ky.) condemns it.
“Obamacare continues to collapse, and we have no choice but to address this problem head on,” Johnson said last week. “Returning more health-care decisions to the states and ensuring equal treatment for states like Wisconsin that spend taxpayer dollars wisely will allow local leaders to tailor their health-care system to the needs of its citizens while maintaining protections for those with high-cost and pre-existing conditions.”
GCHJ’s prospects climbed Tuesday, when 15 Republican governors — including conservative reformers Matt Bevin of Kentucky, Eric Greitens of Missouri, and Scott Walker of Wisconsin — endorsed it.
“Welfare reform passed in the 1990s works because states were given maximum authority along with adequate funding,” these executives wrote Senate majority leader Mitch McConnell (R., Ky.). “Adequately funded, flexible block grants to the states are the last, best hope to finally repeal and replace Obamacare.”
Five GOP governors oppose GCHJ. These include New Jersey’s Chris Christie, Ohio’s John Kasich, and Nevada’s Brian Sandoval — all of whom betrayed their initial, conservative billing. Kasich inhaled Obama’s free samples of Medicaid-expansion money. Now, he craves it like a junkie.
Among conservative public-policy experts, reactions to GCHJ range from cold shoulder to warm embrace.
‐ “It may pass and there are some good things in it, but the Medicaid expansion does not end till 2020,” laments Pacific Research Institute president Sally Pipes. Further, she wrote in a Fortune article, “Blue states are unlikely to ever request waivers. So their residents will be stuck dealing with Obamacare’s high costs and limited choices in perpetuity.”
‐ “The bill is woefully short of full repeal, but if the Senate is going to rush ahead to pass it, then they need to give people relief from Obamacare’s nasty regulations,” says Andy Roth, the Club for Growth’s vice president of government affairs. “This would mean letting the states opt into the regulations, rather than asking the government to let them opt out.”
‐ Betsy McCaughey, a fellow senior fellow with the London Center for Policy Research, keeps it brief: “It’s our only option. So, I vote Yes.”
‐ “I generally like it (there are a lot of good provisions in the bill) with a guardrail: Any person getting a federal subsidy under the legislation should have the option to enroll in a private plan — of their choice — in the private market,” explains Heritage Foundation senior fellow Robert Moffit. “State officials often shove people into government-centric plans, à la CHIP or Medicaid managed-care plans. That should not be allowed to happen here. If that crucial protection can be established in the legislation, we have a down-payment on health reform.”
‐ “GCHJ is a huge step forward in federalism. The states know much better than the federal government does how to get us out of this mess that Obamacare has created,” explains Grace-Marie Turner, president of the Galen Institute. “I would like for it to get rid of all the taxes, but that is not a reason to stop this. . . . Passing GCHJ is a chance for the Congress to meet its obligation to rescue people from this failing law and to show they can govern.”
‘It’s our only option. So, I vote Yes.’ — Betsy McCaughey
‐ John Goodman, author of Patient Power, arguably the first roadmap for free-market medicine, believes that GCHJ is “actually much better than the old Paul Ryan proposal, as far as health reform is concerned.”
‐ “GCHJ begins the erasure of Obamacare,” Grover Norquist, president of Americans for Tax Reform, forecasts. “You don’t have to shred a balloon. A pinprick begins an inevitable process. Ending the mandate to buy. Block granting the spending. Allowing waivers. Passing GCHJ will give the Trump administration its mojo back and set the stage for the coup de grâce: Job-creating tax reform.”
Indeed, a change in today’s tax code, which I have advocated for years, would make a worthwhile, friendly amendment to GCHJ:
Physicians who choose to provide free treatment to poor, uninsured, and underinsured patients could deduct from their taxes the value of that care. Imagine that Dr. Wu sees low-income patients on Mondays from 3:00 to 6:00 p.m. His annual income averages $100 per hour. So, he writes off $300 per week against his taxes, or as much as $15,600 annually.
If this means that hundreds of thousands of doctors owe zero federal income tax because, in essence, they pay in free therapy to the willing needy, then hallelujah!
This will trim federal revenues slightly. But that amount should pay for itself, and how, by relieving emergency rooms and Medicaid.
So, will Republicans splinter anew or coalesce before September 30? Only one thing is certain in coming days: Suspense will mount as debate and negotiations intensify. The No vote of Senator John McCain (R., Ariz.) on Senator Graham’s bill, announced today, heightens this drama and also is a shameful example of a mentor torpedoing a protégé on the most significant project in his career.
“This is the moment,” Vice President Mike Pence told journalists aboard Air Force Two on Tuesday, as he expressed the Trump administration’s support for GCHJ. “Now is the time.”
— Deroy Murdock is a Manhattan-based Fox News contributor and a contributing editor with National Review Online. He has collaborated for decades with many of the organizations and individuals cited in this opinion piece.