Daily Wire

n Wednesday, the House Freedom Caucus endorsed a new version of Obamacare quasi-repeal in the House that would give states the freedom to opt out of federal insurance regulations forcing insurance companies to cover pre-existing conditions and mandated services. The states must pledge that the changes will either reduce prices or increase coverage.

“While the revised version still does not fully repeal Obamacare,” the House Freedom Caucus said in a press release, “we are prepared to support it to keep our promise to the American people to lower healthcare costs. We look forward to working with our Senate colleagues to improve the bill.”

That seems to be the consensus: conservatives are willing to hold their noses and back this version of Trumpcare. Club for Growth President David McIntire said, “While we’re still short of full repeal, this latest agreement would give states the chance to opt out of some of Obamacare’s costliest regulations, opening the way to greater choice and lower insurance premiums.”

In other words, this may be the best conservatives can get.

If so, it’s not very much.

There is a basic problem with this version of Obamacare repeal: it doesn’t repeal Obamacare. It leaves regulations in place on the federal level with regard to insurance companies; the state opt-out merely puts the ball in the court of the states to opt out of Obamacare. But this reverses the federalism polarity: normally, the federal government does not get to participate in a cramdown of federal policy, giving states the option of cancelling it. Instead, the federal government does not get to occupy an area, and states have the obligation to fill it if they so choose.

Here’s why this matters: it’s actually just Congress kicking the can down the road. Now Congress doesn’t have to take the blame for killing the pre-existing conditions and mandated services provisions of Obamacare – they can blame states for doing so. They get to join with Obama in saying they cared about such issues, but those cruel state Republicans wouldn’t get on board. That’s why Congressional moderates could vote for the proposal. But how many governors are actually going to take responsibility for killing the most popular provisions of Obamacare, even if it lowers cost – particularly while the rest of the Obamacare repeal cuts the amount of Medicaid to the states, turning it into a block grant program rather than a need-based program?

Assume you’re the governor of Redland, a Republican state. Obamacare has been the law of the land there, and premiums have risen. You were tough enough not to accept the Medicaid reimbursements for expansion Obama offered. Now you get rid of the Obamacare regulations and go back to the way the system was before; costs may drop overall, but more people lose their insurance because of pre-existing conditions. Or, alternatively, you could just sit tight and wait for insurance companies to pull out of the exchanges, then blame them. Which are you going to do?

Or assume you’re the governor of Purpleland – that you’ve spoken out against Obamacare but you’ve accepted Medicaid expansion dollars. Are you really going to pull out of the pre-existing insurance conditions, which will increase the Medicaid burden in your state, even as the Medicaid block grant program goes into effect? The onus is on you, remember, if things don’t work out in the short term.

This is the problem. Once the federal government fills the field, the entire political burden falls on state actors to buck the standard. That means that while Congress can claim that they’re repealing Obamacare, they’re actually just kicking the can down the road to governors, who will presumably kick the can right back to the feds. Nothing gets better without political courage. And it’s unlikely that such political courage, missing from the federal Republicans, will suddenly manifest at the state level.