Congressional Republicans began trying to repeal the Affordable Care Act (ACA) literally the day after it was passed in 2010. The GOP-controlled House has voted to repeal it many times in a series of completely symbolic exercises that tossed red meat to their supporters without actually accomplishing anything. Now, with the GOP in control of both houses of Congress and the White House, it's abundantly clear that Beltway Republicans have no idea how to follow through on their promise of "repeal and replace" — even though they've had seven years to figure it out.
"We Republicans have looked for a way to end it and replace it with something else without paying a terrible political price. We haven't found it yet, and I'm not sure we will," said Arizona Sen. John McCain on the Senate floor, shortly before three attempts at repeal failed in late July. "All we've managed to do is make more popular a policy that wasn't very popular when we started trying to get rid of it."
McCain is correct. During the last seven years, the ACA has continued to rise in public opinion polls. Even its detractors praise some of its provisions, including coverage for pre-existing conditions and letting young people stay on their parents' policies until age 26. A Gallup poll conducted in April found 55 percent of Americans now approve of the ACA, while only 30 percent want a complete repeal.
Louisiana Sen. Bill Cassidy, a physician who practiced for years in the state's Charity Hospital system, has offered his own alternatives to the ACA, but they largely went nowhere among his fellow Republicans. Cassidy ultimately voted for all three failed Senate repeal bills — after criticizing them for creating "uncertainty in the insurance markets" and warning "premiums will rise for middle class families."
As some in the GOP indicated last week they were ready to move on to other issues, Cassidy teamed up with South Carolina Sen. Lindsey Graham on a "Cassidy-Graham" proposal, provisions of which would violate his earlier promises that any health care replacement would be better and cost less than the ACA.
Cassidy-Graham is complicated, but the biggest change would be block-granting money to the states for them to spend on health care as they choose, on the theory that states will spend it more wisely than the feds. That's a dicey proposition — imagine federal health care block grants being spent by former Gov. Bobby Jindal. Their plan also would end block grant funds entirely by 2026, put a per-capita cap on Medicaid funds, and eliminate both individual and employer insurance mandates.
The end game here is unclear. By 2026, when the federal dollars dry up completely and states must provide all health care funding, Cassidy and most of those who might vote on his legislation will be long gone from office.
This much is clear: The ACA has been the best thing to happen to Louisiana health outcomes in decades. If Cassidy can't improve upon it, he should turn his hand to something else in Washington.