Graham-Cassidy Has One Great Idea
The latest Republican stab at overhauling the Affordable Care Act manages to be both more timid and more sweeping than previous efforts to replace Obamacare. Known as Graham-Cassidy, it was written by a quartet of Republican senators led by Lindsey Graham of South Carolina and Bill Cassidy of Louisiana.

The idea of turning more power over to the states has long been advocated by conservatives, but there are compelling reasons for liberals to get behind devolving power from the federal government.

When Congress passed the Affordable Care Act in 2010, it left many of the details to the discretion of the Department of Health and Human Services, giving vast powers to the secretary to determine everything from fast-food menu labeling requirements to when individuals could purchase insurance. During the Obama years, the administration used its regulatory discretion — pushing and arguably exceeding the limits of the law — to prop up the president’s signature legislative accomplishment as the program ran into implementation problems.

When President Trump took office, he appointed Tom Price, a longtime foe of Obamacare during his time in Congress, to run H.H.S. In the past several months, liberals have shouted “sabotage” as they have witnessed Mr. Price take actions such as slashing Obamacare’s advertising budget, tweaking the rules on the types of plans insurers are allowed to offer and cutting in half — to six weeks — the program’s open enrollment period. Mr. Trump himself has created uncertainty over whether he will continue to authorize payments to insurers that congressional Republicans sued Mr. Obama over.

Any national health care system that assumes one party will control Washington for all eternity is doomed to fail. New Yorkers would have much less to fear about a Trump presidency if the president didn’t control agencies that set policies for the entire country.

From the perspective of somebody who wants to see genuine federalism in health care, Graham-Cassidy leaves a lot to be desired. Because it keeps many of Obamacare’s regulations on the books at the national level, it limits the amount of innovation that can occur at the state level. The fact that it keeps most of Obamacare’s taxes means that states preferring to take a more free market approach will still be paying for a big government footprint in other states. Under one scenario, for instance, Texans could be subsidizing single-payer health care in Vermont.

But the idea of giving states more control over their health care systems should survive no matter what happens with Graham-Cassidy.