If you like your Obamacare plan, your state can keep it. That’s the premise of legislation authored by Louisiana Senator Bill Cassidy which is making the rounds on Capitol Hill.
It’s sort of like the choose your own adventure of replacement packages. The story starts when each state of the union encounters the same three choices. The liberal states on the coasts can keep the Affordable Care Act. The deep red states can repeal completely. And those states in between can work with the federal government to craft a more market based-solution.
There are more intricate details to the tryptic, of course. But the main theme is an attempt to introduce choice into Obamacare without fully erasing the marquee healthcare law. Effectively, it’d let Republicans end their repeal crusade early just as victory appears on the horizon. The bill has plenty of critics on both sides of the aisle, including none other than Cassidy himself.
Before he was a senator, the Louisiana lawmaker advocated for repeal like every other Republican. An accomplished physician with firsthand knowledge of the challenges facing healthcare, he even put together “Ten Good Reasons for an Obamacare Repeal.”
The Medicaid expansion that Cassidy’s bill would keep in place, he once described as a “Medicaid explosion.” In 2011, he warned that Obamacare would stretch the social safety net to its breaking point. “Medicaid, a federal-state partnership designed to give low-income Americans access to healthcare,” he wrote, “is already bankrupting states and barely provides access to healthcare for those who are already on it.”
But the new plan does nothing to change Medicaid’s ballooning cost. Altogether, 32 states have expanded Medicaid under Obamacare, including Louisiana. That sets the stage for an awkward episode on the Bayou. Democrat Gov. John Bell Edwards just celebrated the one-year anniversary of his state’s Medicaid expansion. If the Republican senator gets his way, Obamacare could live to see many more.
In addition to the expansion, Cassidy would keep around Obama’s tax increases. Unsurprisingly, what the senator now wants to keep, he once wanted to abolish. “Not only will these tax hikes eliminate jobs by making it harder for small businesses to expand and hire,” he wrote in 2011, “they will increase the cost of healthcare because many of them target healthcare goods and services.”
Don’t confuse Cassidy for an Obamacare cheerleader though. The senator is just one of the first depressed Republicans openly praying for the serenity to accept a healthcare law he doesn’t think he can change. “We give states the choice,” Cassidy said after introducing the legislation. “So California and New York, you have Obamacare, you can keep it. I disagree with it, but Republicans think power is best held at the state level, not by Washington, D.C., so it’s not for us to dictate.”
Effectively, the Cassidy plan would allow the law to limp on while forcing certain consumers to live under it. Finding decent health insurance would require packing up and moving to a different state. For most families, that’s just not plausible. What’s more, red states would still be on the hook for the fiscal fitness of blue states. The taxes and fees would stay in place to underwrite the states that keep Obamacare.
While the senator does not dispute the problems of Obamacare, he just doesn’t want to tackle them. The diseased federalism beating at the heart of the senator’s bill risks allowing those flaws to metasticize. Failure to completely amputate the Affordable Care Act could prove a diasterous ending for the GOP.
Philip Wegmann is a commentary writer for the Washington Examiner.
