One basic philosophy of the Graham-Cassidy bill was to provide decision making authority closer to where the impacts are felt, i.e., the states. Devolution of power is nice, but beware unintended consequences.
There are lots of decisions that states can make that create entirely different markets separated just by state borders. These differences could lead to migration of underserved people from one state to another and break markets.
Let’s say California maintains the ACA’s pre-existing provisions. And suppose Arizona ends up allowing insurers to charge different prices based on condition. That will leave Arizona with a significant underserved, higher-cost population, some of whom will find California a tempting state to move to. Leading to ever increasing cost pressure on California’s medical system and higher premiums. Some 25% of the U.S. population are supposed to have pre-existing conditions. So, there is significant risk for these kinds of market instabilities.
Maybe the dream of a border wall does not end with the national border. Do states now decide to have similar walls to protect their insurance markets from collapse?
I guess my main concern is that heath care is a big, complex problem. It is one-sixth of the U.S. economy, or about the same size as the Federal Government. You just cannot rush a bill impacting so much of the U.S. without knowing much about the details or the consequences, which I figure is true of the mindset for almost all the senators, representatives and President.