What if Cassidy Graham Had Passed?

At least it pissed off liberals

The Cassidy-Graham monstrosity has now gone down to defeat, but let us take some time to consider what would have happened if it had passed.  Others have considered the policy effects, I am talking mostly about the political effects.

The policy effects for 2018 would be essentially none.  Insurance companies have put in their bids, proposals are up on the exchanges, and 2018 is locked in place.  That being said, there would be at least some damage, not from the bill, but from the Trump Administration’s attempts at sabotage.  Premiums on Oklahoma have gone up by 30% due to Administration neglect, and other states have seen premiums spike from deliberate uncertainty.  Enrollment times have fallen from three month to six weeks, and the Trump Administration has gone out of its way not to warn anyone.  As things stand now, with Republican legislation having conspicuously failed, Republicans can blame all these things on Obamacare and claim that if their legislation had passed these things would not be happening.  If Cassidy-Graham had passed, no doubt with great ceremony, people would automatically blame it for these problems.* 

I am not clear what would happen in 2019.

But it would be in 2020 that disaster would truly strike.  That would be the year that management of health insurance would be turned over to the states.  It is also, all experts agree, not time enough for states to get a system up and running.  And they would be required to do so at much reduced funding, that would continue to shrink over time.  Think of the mess that accompanied the opening of the exchanges in 2014 and raise it by a factor of many.  And just in time for the 2020 election!  I think it safe to say that the general explosion/implosion of the health insurance system during an election year would be a short-term disaster for Republicans.

The bad news is, I see no reason to believe that it would be a long-term disaster.  After all, one would think that a prolonged, highly unpopular war and the biggest economic crisis since 1929 would be a long-term disaster for Republicans, but it ultimately turned out to be a short-term lost, followed by an roaring comeback and unprecedented domination at all levels of government.  Why not turn disaster into victory once again?

The Republican course of action would be simple.  The minute Democrats won, any concern for the public good or attempt to save the healthcare system would be over.  The Trump Administration would spend the interregnum doing everything in its power to wreck the healthcare system beyond what it was already wrecked. 

The sabotage would continue once the Democratic President was inaugurated.  If Republicans retained enough votes in the Senate to mount a filibuster, they would block every attempt to save the healthcare system.  Republic interest groups everywhere would mount litigation to wreck the system in every way possible, and Trump-appointed federal judges would agree with them on every point.  Since many states time their gubernatorial elections to be in opposite years from Presidential elections, Republican governors would largely be protected from the 2020 wave election and would spend the next two years doing everything short of physically blowing up hospitals to wreck the healthcare system so they could blame the Democratic President.

Approximately two days after the Democrat was inaugurated, Republicans would start angrily demanding to know why he hadn’t fixed the healthcare system yet.  Approximately two weeks later, they would be taking out ads laying problems that clearly began before the election at his feet.  Approximately two months later, they would be angrily denouncing Democrats for introducing the disastrous Cassidy-Graham Act that caused that caused this mess.  And in 2022 they would win an unprecedented wave election by running against the healthcare mess that they had created.

And here is the scary thought.  It appears that every time Republicans lose, they respond by getting crazier.  It has proved a highly effective electoral technique.  When Clinton won in 1992, Republican responded by going crazy and won control of Congress for the first time in 40 years.  Although they lost the Presidential election in 1996, in 2000 they won with a candidate of dubious qualification who led this country into a serious mess.  When the country responded by electing a Democrat in 2008, Republican responded by going even crazier and electing a bunch of Tea Party candidates determined to blow everything up.  It proved highly effective in 2010.  When it failed to swing the Presidency to Republicans in 2012, they responded by shutting down the government and nearly causing a debt ceiling breach and were rewarded by a massive sweep in 2014.  And in 2016 they went for the craziest candidate possible and elected Donald Trump, of all people. 

So if patterns hold true and Republicans had gone down to historic defeat in 2020, they would have responded by coming back in 2024 with winning with someone even crazier than Trump!

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*And they would be only half-wrong.  The legislation not have any affect that year, but the same ideological forces driving the legislation would be behind all the problems in the exchanges, so wrong in the details, but right in the generalities.