There are some things that only the federal government can handle effectively…national defense, interstate commerce, a monetary system, and I’d like to add to that health care.

One of the key points of the Cassidy-Graham Healthcare Bill was taking the subsidies and supports currently part of the Affordable Care Act and dispensing them to the states as block grants because the states know best. And the states could ask for waivers of key provisions of the ACA like no life time caps on health insurance or requiring coverage for those with pre-existing conditions or not being able to charge more to the elderly. In essence we could have 50 health care rules out there…one set of rules for each state. Under ACA we don’t have that…except the Medicaid expansion which was only accepted by some of the states…but that wasn’t part of the bill…that was allowed via the courts. Same rules in every state.

One of the unwritten rights we have as Americans (and something that citizens of the European Union have found invaluable) is the right to move where ever we are able. For jobs, for family, for better living conditions, for favored climates, whatever. Pick up and move. The Cassidy-Graham bill would throw a pall over that. Let’s say you lived in Wisconsin and had a pre-existing condition which was covered here…but wanted to move to Indiana. But it wasn’t covered there. Could you still afford to move?

What if Pennsylvania and Idaho say was the only states that kept all of the provisions of the ACA…would they become magnets for all of those with pre-existing conditions or wanted to keep their children on their policies until 26 or were worried about hitting their lifetime caps because of cancer or other disease? Would their insurance markets skew to the old and infirm? Would people feel that they’d have to move there for insurance reasons and no other?

Individual health market rules don’t make sense. They violate any sense of propriety. They’d restrict Americans freedom of movement. It makes no difference if you support fixing the ACA or Senator Sanders’ Medicare for All or some other truly new and improved health care plan…whichever solution wins out in the end…it needs to be nationally universal.

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