Rick Santorum, the fifth - and most influential - senator behind the GOP's latest health-care bill | Opinion
Santorum makes the case that the central feature of welfare reform in the 1990s - block-granting federal funds to the states - should be the central feature of health-care reform.
As Sen. Lindsey Graham speaks about health-care reform at a news conference on Sept. 13, behind him are (from left) Sens. Bill Cassidy, Dean Heller, and Ron Johnson, and former Sen. Rick Santorum.Read moreOlivier Douliery / Abaca Press / TNS
by Colin A. Hanna
Next week, one of the most important pieces of legislation to come before Congress this year will be voted on by the Senate. It's the latest and perhaps final Republican proposal to replace ObamaCare.
The bill is largely attributed to Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, although Nevada's Dean Heller and Wisconsin's Ron Johnson were also involved in writing and promoting it. But there's a fifth senator in the mix: former Pennsylvania Sen. Rick Santorum, and he may have been the most influential of all, even though entirely behind the scenes.
Santorum has brought his experience as the originator, prime promoter, and, ultimately, Senate floor manager of the welfare reform bill in the 1990s to the current health-care reform effort. He had originally presented the block grant framework for health-care reform to the House, but members were committed to backing Speaker Paul Ryan's bill. Similarly, when presented to GOP senators, Santorum's proposal took a back seat to Senate Majority Leader Mitch McConnell's legislation. And with Congress cool to the proposal, Santorum couldn't get much traction with Republican governors either.
Yet, Santorum persisted. He eventually won the support of Graham and then Cassidy, whose own credentials as a physician were an asset. Next came Heller and Johnson. In July, Santorum gave a presentation to the Republican Governors Association. But it wasn't until this month, when all the pride-of-authorship bills had failed on their own, that the former senator's plan began to be taken seriously.
Santorum made the case that the central feature of welfare reform — block-granting federal funds to the states — should be the central feature of health-care reform. This is the most important feature of the bill, and thus all other objections to it should be considered secondary.
Nearly all the concerns raised about Graham-Cassidy are based on fear of funding cuts, not the block grant structure. The objections of Sen Susan Collins are based entirely on the potential loss of funds to Maine that amount to little more than one percent of the state budget. This is exactly the kind of reaction to federalism that she must know is flawed. A well-designed, well-run state program could achieve efficiencies greater than that small shortfall.
The fact is the distribution of Obamacare funds was highly disproportionate. For instance, three states — California, New York, and Massachusetts — receive 37 percent of all Obamacare funds, while they account for only 20 percent of U.S. population. Restoring equity, which the new GOP bill tries to achieve, necessarily requires a disproportionate impact.
Sen. Rand Paul (R., Ky.) claims that this new bill is Obamacare Lite. No, it's whatever a given state wants it to be, within some limits, but it's not limited to a "lite" version of Obamacare.
Jimmy Kimmel claims that the new bill may not cover preexisting conditions. The nursing home trade association fears Medicare and Medicaid cuts. Both objections are factually flawed, but that's not the point. Any genuine inequities can be fixed later. The one thing that can only be changed before the end of September is enacting the basic concept of block grants in place of top-down federally dictated health care.
Sept. 30 is the very last day that the Senate can approve a health-care reform bill under the reconciliation rule that avoids filibuster. No Democrat is likely to support the block grant model, so it must rely on Republican votes alone. All funding formulas — Medicare, Medicaid, subsidies, and grants — can be tweaked later, and Senate rules will require bipartisan agreement. But for now, the primary focus should be on structure. Every Republican senator should support the transformational, long-term benefits of block granting the program rather than running health care as a monolithic federal program.
Simply repealing Obamacare without replacing it is utterly unrealistic. That leaves three options for the future of health-care financing in America: permanent ObamaCare, which is collapsing and financially unsustainable; Bernie Sanders' single-payer socialized medicine; or block granting federal health-care money to the states. This third option would set the stage for state-based innovation. States that don't want to innovate, and want to stay in a plan that's basically Obamacare, are free to do that.
Here is something to remember about the block-grant model as applied to welfare reform: It worked. It reduced unemployment, promoted and incentivized work, and restored dignity and independence to millions of previously dependent citizens. Graham-Cassidy can achieve similar results for health care.
The storm of partisan rhetoric against the bill has escalated beyond Category 5 intensity to the point of pure demagoguery. The major media — both news and entertainment — are exhibiting the kind of over-the-top rage that comes from genuine fear that this bill could pass.
Republican senators should look at the big picture: The chance to change the basic funding model to block grants expires on Sept. 30, never to occur again. They should support Graham-Cassidy. The alternatives are unacceptable.
Colin A. Hanna is president of Let Freedom Ring. colin@lfrusa.com
Colin A. Hanna