Rubin: GOP taking three big gambles with health care

The Washington Post reports on the latest health care effort from Sens. Bill Cassidy, R-Louisiana, Lindsey Graham, R-South Carolina, Dean Heller, R-Nevada, and Ron Johnson, R-Wisconsin:

“The latest proposal would give states control over billions in federal health care spending, repeal the law's key mandates and enact deep cuts to Medicaid, the federally funded insurance program for the poor, elderly and disabled. It would slash health care spending more deeply and would probably cover fewer people than the July bill - which failed because of concerns over those details.”

The bill also leaves open the possibility that states may radically cut back on the type of coverage offered and what has been a nearly iron-clad protection that those with pre-existing conditions cannot be denied coverage or priced out of the market.

In other words, one major risk for Republicans is that this bill passes and Republicans are held accountable for a severe disruption to the health care system that results in less coverage for those who need it the most.

Louisiana's health department secretary, Rebekah Gee, already wrote a letter lambasting Cassidy, pointing out that 433,000 people in his state will lose Medicaid. She blasted him for his plan's inclusion of per-capita caps on Medicaid that would cut services or the numbers who may be covered (or both). She calculated the bill would cost her state $3.2 billion through 2026, making it the eighth-biggest loser among states and “by far the poorest and sickest” state to get hit.

A second risk is that the Republicans get themselves all ginned up again, only to find they lack the votes to pass the newest health care scheme. They will be ridiculed, embarrassed and divided all over again, giving fuel to Stephen Bannon and his primary challengers and reigniting Trump's fury at Republicans. It would also serve to remind Democrats that to prevent Republicans from trying again and again to repeal Obamacare, they must turn out in 2018 to win back the majority in at least one house.

There is a third, more interesting risk. Sen. John Kennedy, R-Louisiana, posited that if Congress gives “a big chunk of money to California they're going to go set up a single-payer system run by the state and then come back and say, ‘We don't have enough money, we need more.'?”

That is not altogether fanciful. Sen. Bernie Sanders has rolled out his single-payer idea. If Obamacare is dismantled and money simply handed over to the states, every blue-state governor will come under pressure to try a single-payer system. The “laboratories of democracy” will be put to work test running the one health care system Republicans dislike more than any other: single-payer. If a substantial number of states try this out, it may be virtually impossible for other states to resist. If, say, New York, New Jersey, California and some New England states all go to single-payer health coverage, private insurers might not survive to offer coverage in other states.

Imagine the egg on the faces of conservatives if they manage to spur creation of single-payer health care in the United States. After all, Trump did promise he'd cover “everybody,” didn't he?

Jennifer Rubin is a columnist for the Washington Post.