A few weeks ago, I wrote in this space about the merits of shifting federal health care programs – and the funding thereof – to the states. As a governor, I saw first-hand that the state was better equipped to fashion effective programs at lower cost, as opposed to dealing with one-size-fits-all federal mandates and red tape.
In fact, I have long said that federal Medicaid dollars should simply be sent to the states in the form of block grants, allowing 50 laboratories of innovation to come up with programs that work, and to eliminate what doesn’t work.
After embarrassing and shameful failures to repeal and replace Obamacare, the U.S. Senate is trying one more time. Interestingly, their latest proposal is to send the federal dollars to the states in the form of, yes, block grants.
Don’t get me wrong. I’m nowhere close to “endorsing” the Graham-Cassidy proposal that now appears to be in play. The devil is in the details, and it doesn’t repeal many of the taxes and mandates that were imposed by the infamous and unworkable Affordable Care Act. For all those reasons and more, I sympathize with those who are opposing it – including some governors who are concerned about a less-than-comprehensive approach to replacing Obamacare.
But, in my eight years as Governor, especially with a legislature who often didn’t exactly embrace my free market, less-government-is-better philosophy, I learned that governing is unavoidably an incremental exercise. Injecting the notion of providing federal health care assistance by way of block grants to the states is an encouraging “increment.” I hope it is a notion that persists, regardless of how the larger debate plays out.
The health care-industrial complex is already decrying their pain
Of course, we are already seeing the headlines and cries of pain about how many millions of Americans would be denied care under the Graham-Cassidy plan. Ending the Medicaid expansions encouraged by Obamacare, they say, equates to hundreds of billions of dollars in “cuts.”
Many in the health care industrial complex are already decrying the revenues they will lose. It’s the same tunes we have heard again and again whenever anyone talks about repealing the unworkable and bankrupting health care law.
Here’s the problem with the doomsayers’ claims: They assume that shifting programs from Washington to the states won’t save any money. And they assume that the elected leaders in the states will somehow lack the compassion and care for those in need that federal bureaucrats can provide.
Both of those big government assumptions are just wrong. Under a block grant approach, if California wants to double-down on government-provided health care, they can try it. It will succeed, or it will fail. New Mexico and New Jersey can try something different. But ultimately, the successes and failures will come from a level of government closer to the people and their specific needs.
Special interests don’t want to give states any credit
Twenty years ago, when Congress enacted welfare reforms that capped funding for certain programs, but replaced those programs with block grants to the states, the same doom-saying was heard. Then, as now, the special interests and politicians weren’t willing to give the states any credit for being able to provide services more efficiently and cost-effectively.
By most accounts – and according to a lot of data – welfare reform worked out OK. The sky didn’t fall, a couple of out-of-control entitlement programs were brought under control, and with much of the red tape and bureaucracy out of the way, some states actually ended up with more funding to put to use actually helping those in need.
Who knows if Graham-Cassidy would produce a similar result? But to the extent it represents a step toward the very American and constitutional concept that the states are more appropriate “managers” of government programs, the simple fact that we are talking about block grants in place of federal control is worth noting.
Let’s hope it is a trend.
(Sen. Bill Cassidy, R-Louisiana, speaks as Sen. Dean Heller, R-Nevada, and Sen. Lindsey Graham, R-S.C., listen during a news conference on health care September 13, 2017 on Capitol Hill in Washington. Senators Graham, Cassidy, Heller and Ron Johnson, R-Wisconsin, unveiled a proposed legislation to repeal and replace the Obamacare. Photo by Alex Wong/Getty Images.)