Lindsey Graham is one of the only Republicans in Congress excited about President Donald Trump’s announcement last week that the GOP should be “the party of health care.”
In fact, South Carolina’s senior U.S. senator is ready to make repealing and replacing the Affordable Care Act — and his leadership in that effort — a centerpiece of his 2020 re-election campaign.
“I welcome the debate,” Graham said recently on Capitol Hill.
“We’re going to have a 2020 election, and one of the issues will be health care,” he added. “We know what we don’t like. I think Obamacare’s gonna fail. But we owe it to the public to say what we do like.”
For Graham, who officially launched his re-election bid over the weekend, the strategy carries some political risk.
“If that’s what he wants — if that’s a fight he wants to have — we’re gonna do it,” said Jaime Harrison, the Democrat poised to run against Graham next year. “There is no way in the world we’re going to allow folks in South Carolina who have health care coverage in the first time in a long time to lose it because Lindsey Graham is trying to continue to play footsie with the president.”
Plenty of voters who make up Graham’s base back home don’t like the current federal health law, enacted by Democrats in 2010 under the leadership of President Barack Obama. Since that time, South Carolinians have seen premiums increase, and the state is now down to just one provider offering insurance through the federal marketplace.
But Republicans tried, and failed, to repeal and replace Obamacare in 2017, when the party controlled both chambers of Congress and the White House. Graham’s proposal to send all Obamacare money back to the states in the form of block grants — controversial among his own colleagues — was the GOP’s final pitch before declaring defeat.
Heading into a presidential election year, many GOP lawmakers would rather not re-live that political humiliation and remind voters of their failure to deliver a major campaign pledge from 2016.
Yet Democrats were able to re-take control of the U.S. House in part by accusing Republicans of trying to do away with an Obamacare provision prohibiting health insurance plans from denying coverage to patients with pre-existing conditions.
And it’s that perception — that Republicans wants to take away people’s health care — that Graham says his party needs to change.
“I told the president pre-existing conditions hurt us in 2018,” Graham said. “People think (Republicans) are somehow against sick people being covered. Nobody is.”
Graham said he’s talking to colleagues about revising the block grant proposal, informally known as “Graham-Cassidy,” named for Graham and his main partner in the effort, U.S. Sen. Bill Cassidy, R-La.
“We had a conversation about it as soon as the president declared we’re the party of health care,” added U.S. Sen. Ron Johnson, R-Wis., a Graham-Cassidy supporter.
The original Graham-Cassidy plan would eliminate the requirement that individuals and businesses buy health insurance for themselves or their employees or face financial penalties; protect people with pre-existing conditions; retain a tax on the wealthy; and repeal the medical device tax.
Though there is little chance of this plan advancing now, Graham could get credit simply for pitching any proposal when his party has been criticized for having few, if any, ideas.
“Lindsey Graham’s always been a risk-taker,” said Matt Moore, a GOP consultant and former chairman of the S.C. Republican Party. “He’s smart to appeal to those center-right voters who are motivated by health care … who (Republicans) lost in 2018. It’s not an option to have no position on health care.”
Still, Graham’s position might not be popular among voters.
A September 2017 hearing on the block grant proposal in the U.S. Senate erupted in an emotional, chaotic scene in which demonstrators — some with physical disabilities — were dragged from the committee room by Capitol Police as they shouted their opposition.
At that time, a nonpartisan Congressional Budget Office analysis of Graham-Cassidy estimated that “millions” would lose health insurance coverage if the plan were enacted, and that Medicaid enrollment would sharply decrease.
South Carolina already has low participation in Medicaid because the state’s Republican leadership refuses to expand the program. According to March 2019 data from the U.S. Centers for Medicaid and CHIP Services, just over 1 million South Carolinians are enrolled in the program for low-income individuals.
Graham and other proponents say block granting health care funding would give states flexibility to come up with their own plans to meet the unique needs of their residents.
“If California wants ‘Medicare for all’ for healthcare, they can have it,” Graham said. “South Carolina will do something else.”
Critics say it could result in a lack of oversight that won’t necessarily direct health care money to the right places.
“Right now, there are specific requirements about whether funds are being spent and where they’re going,” said Lathran Woodard, CEO of the S.C. Primary Health Care Association. She was recently on Capitol Hill to advocate for reauthorizing funding for community health care centers, which received a major boost in the Affordable Care Act.
“We feel strongly that what is in place in terms of the way health centers get their dollars, it’s working. We have so much oversight. The money is going to the purpose it’s meant for,” Woodard continued. “Giving states flexibility and freedom, I understand that, but would the money go to the under-served areas?”
Sue Berkowitz, the executive director of S.C. Appleseed Legal Justice Center, said health care funding through block grants could end in a repeat of the problems South Carolina has experienced with the Temporary Assistance for Needy Families block grant program.
Berkowitz, whose organization advocates for low-income South Carolinians, said the TANF block grants have never been generous enough, or optimally utilized, to make a true difference.
“Poverty went up, people having the ability to benefit from the TANF program went way down, childhood poverty has gone way up, and the resources never increased,” she said.
Graham is heading into his re-election with a strong upper hand. Recent polling shows him popular among Republicans, and any Democrat — even a well-connected former state party chairman like Harrison — faces an uphill battle in a state Trump won in 2016 with 55 percent of the vote.
But Harrison, who was on Medicaid for part of his childhood, thinks he will be at an advantage if Graham makes health care a part of the debate.
“It would be really good for me,” Harrison said, “because I’m going to wear him out of this issue.”