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South Carolina U.S. Sen Lindsey Graham is on a mission to make changes in the U.S. health care system. His efforts may not succeed and are being labeled as politically motivated to help Republicans live up to their long-running promise to repeal and replace Obamacare (the Affordable Care Act).

The critics are not being fair.

First, Graham’s proposal is not new. He’s been pushing it hard since failure of earlier attempts by the GOP to pass health care reform — it’s just that not many people have been listening until now.

Second, Graham is a Republican and a conservative, but he is not a lawmaker opposed to working with Democrats. He has a reputation for working across the aisle to find compromise. He is consistent in his message that Obamacare is failing and will collapse.

Sadly, as much as some Democrats may want to support Graham’s plan, none will do so because it is packaged as GOP repeal-and-replace. Democrats are determined that President Barack Obama’s signature accomplishment will not be scrapped.

Graham, with co-sponsor Sen. Bill Cassidy of Louisiana, is proposing replacement of major components of the ACA with block grants to states to design their own programs.

The Graham-Cassidy bill would end the requirement that most people buy health coverage and that larger employers offer it to workers. It would let insurers charge higher premiums to seriously ill customers and cut Medicaid, the health insurance program for the poor, over time.

The law would end health insurance subsidies and provide $1.2 trillion in block grants to states over seven years, with fewer federal strings attached.

The money is a crucial issue in gaining support.

The consulting firm Avalere Health stated the bill would lead to an overall $215 billion cut to states in federal funding for health insurance, through 2026.

The nonpartisan Kaiser Family Foundation said the plan will take federal dollars away from states that expanded Medicaid under the ACA. States that didn't expand Medicaid — including South Carolina — would initially get more federal dollars, an estimated 12 percent increase.

Yet the most heated debate is over coverage for people with pre-existing conditions.

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The guarantee of Obamacare would be replaced. Though insurers could not turn away those with pre-existing conditions anywhere, states could opt to once again allow carriers to raise premiums because of people's medical histories and to sell skimpier policies that don't cover Obamacare's 10 essential health benefits. And insurers would be able to cap the amount they would pay for treatment outside what their states deem an essential health benefit.

With even its proponents arguing Obamacare has serious flaws and its critics beyond just Graham contending the health care program is going to collapse, something must be done. Shifting money and decision-making from Washington to the states is a workable alternative.

Critics argue relying on the states will create 50 different systems and disparities in care. But there already are 50 different systems as the situation in every state — from insurance providers to Medicaid management — is different. Many states have rejected key provisions of Obamacare.

Republicans controlling the Senate by a 52-48 margin must vote before Sept. 30, after which 60 votes would be needed for passage. With Democrats unanimously opposed, those votes are unattainable. Even now, the prospects for Graham-Cassidy are at best uncertain largely because Obamacare opened the door to guaranteed coverage for all and any plan that pulls away even remotely from that — for example, raising costs for those with pre-existing conditions — is hard to sell, even to Republican voters.

In the end, reaction that Republicans get to the plan between now and the vote will determine whether Graham-Cassidy becomes the model for replacing Obamacare.

If the legislation fails to get Senate approval, the focus by necessity has to return to reforming Obamacare. But congressional compromise, even if it could be achieved, is not likely to result in universal acceptance.

A lot is at stake. Looming on the horizon is Sen. Bernie Sanders’ proposed legislation for a government takeover of health care, which proponents see as a logical next step after Obamacare.

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