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Opinion: The Fatal Flaw for Republicans in Graham-Cassidy

Bill’s passage would make health care dominant issue in 2018 midterms

The Republicans’ latest attempt to repeal President Barack Obama’s health care law is reminiscent of “The Charge of the Light Brigade,” Shapiro writes. (Painting by Richard Caton Woodville/Wikimedia Commons)
The Republicans’ latest attempt to repeal President Barack Obama’s health care law is reminiscent of “The Charge of the Light Brigade,” Shapiro writes. (Painting by Richard Caton Woodville/Wikimedia Commons)

The Republicans’ latest drive to repeal Obamacare is reminiscent of a poetry fragment from Tennyson’s “The Charge of the Light Brigade”: “Theirs not to make reply, theirs not to reason why.”

Whatever happens with the bill likely slated to reach the Senate floor next week, it is hard to escape the feeling that this wild charge will end badly for the Republicans.

In belatedly pushing the legislation (sponsored by Lindsey Graham, Bill Cassidy, Ron Johnson and Dean Heller), Mitch McConnell and the GOP leadership have absorbed none of the lessons from the dramatic failure of the last Senate repeal effort with an ailing John McCain casting the decisive “no” vote.

What has been baffling the Republicans since the days of Social Security and then Medicare is that social welfare programs with middle-class beneficiaries grow more popular over time. American voters, for understandable reasons, do not support legislative efforts to take away benefits that they have been receiving.

As a result, the only voters still passionate about repealing Obamacare are hardcore conservatives.

A Quinnipiac University poll, conducted in early August, found that 60 percent of registered voters (including 28 percent of Republicans) believe that it is time for Congress to move on. And recent surveys have also found that a majority of voters now approve of the once-reviled 2010 legislation known as Obamacare.

Even though it was developed without any congressional hearings, Graham-Cassidy is a complex piece of legislation with enough moving parts to satisfy Rube Goldberg. At its core, the bill would return most of the Obamacare money to the states to develop their own health care plans.

Meeting with reporters Tuesday afternoon, both Graham and Cassidy warbled about the virtues of this federalism. They almost made it sound like James Madison would have added Graham-Cassidy to the Constitution if only he and the other framers had thought of it.

As Graham put it in terms of his native South Carolina, “If you don’t like Obamacare, who do you complain to? You can complain to me, but I sure as hell don’t run it. If I can get South Carolina in charge of this money that would have been spent in Washington by a bureaucrat who is unelected, I promise every South Carolinian the following: ‘If you don’t like your health care, somebody will listen to you.’”

A fatal flaw

These comments are worth analyzing in detail because they point to the fatal political flaw in the proposed legislation. In exchange for protecting nervous GOP senators from the wrath of a Donald Trump tweet, the legislation risks a bloodbath for the Republicans in the 2018 gubernatorial elections.

Not only would Graham-Cassidy squeeze Medicaid spending across the board, but it would also transfer funds from the 31 states that have expanded the program under Obamacare to the 19 states (virtually all Republican) that have not.

Cassidy explained the politics of the bill in these blunt terms: “If you’re in a state that hasn’t expanded Medicaid, you’re going to do great.” Left unmentioned was the awkward fact that Cassidy’s home state of Louisiana has enrolled more than 400,000 people in an expanded Medicaid program.

Geography is not the only reason why there would be vocal losers under the legislation.

Graham-Cassidy encourages states to seek federal waivers to experiment with the package of health care benefits that insurers must provide. What this means is that parsimonious states could offer little more than catastrophic coverage or permit insurance companies to charge differential rates for people with pre-existing conditions.

If the Republicans are successful with this last-ditch “repeal and sorta replace” crusade, the remnants of Obamacare will land in 50 state capitals with a thud. Twenty-seven Republican-held governorships are on the ballot in 2018. And thanks to Graham-Cassidy, health care would suddenly become the dominant issue in many of these races.

Remember that Graham wants voters to be able to complain about health care to their governors. He said at Tuesday’s press conference, “You can go to your governor who will listen to you because they care about your vote if nothing else.”

The class of governors elected in 2018 will be major players in congressional redistricting after the 2020 Census. It would be devastating to the Republicans if states like Florida, Michigan, Ohio, Illinois and Wisconsin elected Democratic governors running on the newly energized health care issue.

Hitting close to home

But the Senate itself is also vulnerable to the ripple effects from the passage of Graham-Cassidy.

Both Heller, a bill sponsor from Nevada, and Arizona’s Jeff Flake are facing shrill primary challenges from the Trump wing of the party. While voting for Graham-Cassidy may help the two senators survive a primary, the vote becomes another factor complicating their fall re-election campaigns in states that expanded Medicaid.

Passage of Graham-Cassidy remains a dicey proposition since the mechanism to pass the legislation with only Republican votes turns into a pumpkin at the end of the month.

In an effort to placate McCain and his talk of “regular order,” the Senate Finance Committee will hold a hearing on Graham-Cassidy on Monday. Of course, since the legislation has already been sent to the Congressional Budget Office for scoring, the hearing will only be for decorative purposes. It will be the Senate equivalent of the “sentence first, trial later” approach to justice in “Alice in Wonderland.”

It remains difficult to understand why, beyond stubbornness, Senate Republicans have returned to the fray over Obamacare.

If Graham-Cassidy is defeated, it will point up the ineptitude of Senate Republicans under McConnell. And if it passes Congress, the GOP will be on the hook for the resulting benefit cutbacks for years to come.

Roll Call columnist Walter Shapiro is a veteran of Politics Daily, USA Today, Time, Newsweek and The Washington Post. Follow him on Twitter @MrWalterShapiro.  

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