The Graham-Cassidy health care bill appears to be mercifully dead, as Senate Majority leader Mitch McConnell said Tuesday that Republicans would not vote on the bill. It’s possible that the measure, which already is in its fourth iteration, could be changed once again to entice wayward Republicans. But Graham-Cassidy is caught in the same taffy pull as previous attempts at Obamacare repeal. Make the bill more conservative, and moderate Republicans will flee, and vice versa. Call it death by intra-party politics. A pre-existing condition.
Such a death would be merciful not only for Republicans, who would avoid the self-inflicted wound of passing deeply unpopular legislation, but for the millions of Americans who would have lost coverage or seen premiums skyrocket had Obamacare repeal passed. That’s especially true in North Carolina, which is dodging a bigger calamity than many states if Graham-Cassidy stays dead.
Why? Graham-Cassidy would have given states more flexibility and control over health care coverage by converting Obamacare funding into block grants that states would use to set up their own programs. That approach would allow states to be more attentive and innovative than the feds in meeting their constituents’ health care needs, Republicans say.
There’s a structural flaw to that kind of thinking, however: Conservative state legislatures like North Carolina’s aren’t interested in finding innovative approaches to health care. Innovation to many N.C. Republicans is finding new ways to get government out of our lives, not more involved.
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In the unlikely event that Graham-Cassidy is revived and passed, N.C. Republicans wouldn’t opt to keep Obamacare’s exchanges or try something new. They would revert to ideological form and let the private sector determine how health care is delivered and covered. That means handing the keys back to insurance companies, just as in the pre-Obamacare days. That also means lifetime caps and essential benefits like some doctor visits would likely be eliminated, and it could mean people with pre-existing conditions would see premiums spike. One certainty: As many as a million North Carolinians would lose insurance coverage as plans become more expensive and federal Medicaid money dries up, experts say.
North Carolina’s congressional delegation surely knows this about our state lawmakers, which makes it all the more disheartening that N.C. Republicans in Washington have not offered a peep of opposition to Graham-Cassidy. That includes Sen. Thom Tillis, who is once again fashioning himself as a moderate but has not walked the walk by opposing Graham-Cassidy and supporting a bipartisan effort to shore up Obamacare’s weaknesses.
Tillis and most Republicans seem to be counting on a more cynical calculation – that keeping their promise to repeal Obamacare won’t cost them the votes of conservatives, even those whose health care would be compromised. North Carolinians may have dodged another bad health care bill this week, but the battle over the future of Obamacare is far from over.