Congress has one final chance to replace Obamacare this year, and it should seize the opportunity.
The Graham-Cassidy-Heller-Johnson bill , named after its four Senate sponsors, is actually the result of an effort spearheaded by former Sen. Rick Santorum, R-Penn., whose central insight for the bill was drawn from the single most successful domestic-policy reform of the past half-century.
Santorum knows what he's doing: He was the Senate floor manager of that huge success story, the bill that reformed the nation's largest welfare program in 1996. Using rough numbers, that law cut welfare rolls nearly in half, saved federal taxpayers hundreds of billions of dollars over the next 20 years, actually sent more aid to truly-needy individuals, and helped cut the poverty rate significantly.
While that welfare-reform law had plenty of features, two were most significant. One was a work requirement for recipients – something not directly applicable to healthcare, except for its Medicaid component. The other, the structural one, eliminated the federal government's operational bureaucracy by block-granting the program's funds back to the states, while giving the states broad freedom to design their own plans for how to use those monies.
It is that latter structural reform that forms the template for GCHJ. While repealing the philosophically objectionable individual- and employer mandates and expanding money for Health Savings Accounts (another successful idea first introduced in the 1990s by Santorum), GCHJ provides states ample financing while largely leaving them free to tailor their own healthcare policies.
The amount of the block grants would still grow over time, but not as fast as federal healthcare spending has been growing under Obamacare. But because the states would know and understand the formula in advance, and because they would have such freedom to use those funds in creative ways to expand coverage with less bureaucratic overhead, the results would probably match the triumphs of the 1996 welfare reform.
"Get the money out of Washington and put it in the states," Santorum emphasized in a Mobile, Ala., radio show I hosted last week. That's almost always a formula for success. As the Wall Street Journal noted in an approving editorial, "Reform-minded governors would have the chance to create showcases for insurance-market innovation."
This is what happened, state by state, with welfare reform. Wisconsin was one of the earliest success stories, significantly cutting poverty. Arkansas used the reform to vastly improve its services in higher education (as a way out of the welfare trap). Maine, rather late to the take advantage of welfare reform's possibilities, nonetheless already is seeing huge benefits from its reforms implemented in 2014, with one report showing "more employment, higher wages, and less dependency."
Meanwhile, because GCHJ's formula over time would likely send more money to less-wealthy states such as West Virginia, its sponsors may even be able to entice Democrats such as Sen. Joe Manchin, D-W.V., to vote for the bill. The bill also would repeal the medical device tax, thus pleasing ISen. Joe Donnelly, D-Ind., one of that tax's most vociferous opponents. (It might help if the White House and Senate leadership actually made a real effort to get Manchin or Donnelly, or Sen. Heidi Heitkamp, D-S.D., to vote for the bill.)
And because GCHJ isn't a one-size-fits-all national program, liberal states such as New York and California would be perfectly free to keep the Obamacare system in place within their own borders. Hard-core conservatives might hate this feature of the bill, but it relies on a prototypically "conservative" insight: When states compete with each other by offering different policy options, it is the public that usually benefits.
Because so many states clearly will ditch Obamacare under GCHJ, it will make it that much harder for the Left to once again nationalize healthcare policy. GCHJ is thus the best imaginable defense against a national "single-payer" system, with all the heavy-handed healthcare rationing sure to accompany it.
Only 12 days remain to pass GCHJ under current "reconciliation" rules that allow it to be passed with just 50 votes. If it passes and then needs to be tweaked here and there in a year or two, those tweaks can be made.
But if it doesn't pass, the dreadful Obamacare system will probably be here to stay. Obamacare must be replaced, and GCHJ is the last, best hope to do it.
Quin Hillyer (@QuinHillyer) is a contributor to the Washington Examiner's Beltway Confidential blog. He is a former associate editorial page editor for the Washington Examiner.
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