Health-Care Policy Experts Debate Merits, Demerits of Graham-Cassidy | Eastern North Carolina Now

    Publisher's note: The author of this post is Dan Way, who is an associate editor for the Carolina Journal, John Hood Publisher.

    As Republicans try to spark what many see as their last, best effort to repeal Obamacare, health-care analyst Avik Roy is throwing dirt on the Graham-Cassidy bill.

    The bill, sponsored by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, could come up for a Senate vote next week.

    Roy is the opinion editor at Forbes and president of The Foundation for Research and Equal Opportunity, a free enterprise think tank in Texas. He spoke as part of a panel discussion at the annual State Policy Network conference in San Antonio last month.

    He sees a lot of energy behind the scenes to rally support for the legislation, but it's unlikely 50 senators would support the bill, which would eliminate Obamacare's individual and employer mandates to buy health insurance and scrap the medical device tax. Most of the Obamacare taxes would remain in place, but the tax revenue would be shifted to the states.

    When conservatives talk about block grants, "We all just kind of jump up and say, 'That's awesome.'"

    But he fears Graham-Cassidy would be block grants in name only. The federal government won't relinquish more than $1 trillion in taxes to the states without mandates and restrictions, Roy said.

    Katherine Restrepo, director of health-care policy at the John Locke Foundation, isn't as skeptical. She thinks North Carolina could gain more block grant flexibility in restructuring not only its private health insurance market but also its Medicaid program.

    Roy doesn't envision Graham-Cassidy leading to much-needed insurance deregulation or free market reforms, such as imposing a co-pay on Medicaid participants.

    Cassidy and Graham won't necessarily man the front lines of the 10th Amendment umbrella of federalism, allowing states to exert broad flexibility for state-based solutions, Roy said.

    Cassidy was an aggressive critic of free-market senators who wanted to abolish Obamacare's guaranteed issue and community rating provisions, Roy said.

    Guaranteed issue allows a person to buy health insurance after they get sick, which reduces the need to maintain continuous insurance coverage. Community rating makes it illegal to charge premiums based on a person's gender or age.

    U.S. Sen. Lamar Alexander, R-Tennessee, also is working on a bill in the Health, Education, Labor and Pensions Committee he chairs. Roy thinks every Senate Democrat would vote for it, and Alexander says he has 10 Republicans who would back it.

    Alexander claims to be an Obamacare repeal proponent but is concerned about 350,000 Tennesseans in jeopardy of losing coverage under their Obamacare plans. His bill is intended to stabilize Obamacare by continuing cost-sharing payments to insurance companies to prevent them from pulling out of the health-care exchanges.

    Roy said Senate Majority Leader Mitch McConnell, R-Kentucky, is unlikely to bring Alexander's bill to a floor vote if support is all from the center and left. But if conservatives exert pressure to propose state flexibility in exchange for keeping Obamacare's cost-sharing provisions intact, McConnell might allow the bill to move out of committee.

    Restrepo said regardless of what happens at the congressional level, states can be more nimble in enacting health reform policies promoting better access to health care.

    "North Carolina has the ability to make its health-care market more competitive and bring lower costs to patients without any federal intervention," Restrepo said.

    She said the state should repeal protectionist laws such as certificate of need or statutes that prevent mid-level health-care providers from practicing independently to the full extent of their medical training, unless they are supervised by a physician.

    Removing licensure barriers to expand telemedicine and passing laws that protect direct primary care providers are other examples of needed state-based reforms, Restrepo said.

    Naomi Lopez Bauman, director of health-care policy at the Goldwater Institute in Arizona, added to Restrepo's list allowing pharmacists to provide services for which they're medically qualified. She said in people in Texas often cross into Mexico to obtain lower-cost health care, especially dental work, at pharmacies and retail clinics.

    The Obama administration blocked every common-sense free market reform submitted to it, Lopez Bauman said during the SPN conference.

    It's a new environment under Trump, she said. States should submit bolder reform plans that the federal Department of Health and Human Services said it wants to see from states.