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Republicans take aim at their own constituents' health care

States like Arizona, Louisiana, and Nevada would be punished by the Republican health care plan. So why are Republicans from these states supporting the plan?
Senate candidate, Rep. Bill Cassidy, left, talks to the media in Shreveport, La. on Oct. 14, 2014.
Senate candidate, Rep. Bill Cassidy, left, talks to the media in Shreveport, La. on Oct. 14, 2014.

Yesterday morning, many involved in the health care debate were keeping an eye on Arizona Gov. Doug Ducey (R). The thinking was, if the Republican governor balked at the Graham-Cassidy health care plan pending in the Senate, Sen. John McCain (R-Ariz.) would use Ducey's opposition as reason to reject the bill, which would likely kill it.

Some health care advocates were cautiously optimistic: independent analyses showed that Arizona would be punished more than most states by the Republican health care overhaul, so it stood to reason that Ducey would announce his opposition to the legislation -- if for no other reason, because it would hurt the interests of his own constituents.

As it turned out, however, it didn't matter. The Arizona governor formally endorsed the plan anyway, making it a bit more likely that McCain will do the same.

It's all quite counter-intuitive. Ordinarily, explaining to policymakers that their own states would suffer as a result of a proposal is usually a powerful argument, since elected officials are supposed to be reluctant to undermine the interests of the voters who put them in office. But when it comes to health care, and the Graham-Cassidy bill in particular, this doesn't seem to matter as much as it should.

The latest Senate Obamacare repeal bill would "uniquely" and "disproportionately" hurt a key sponsor's home state, according to the Louisiana Department of Health.Louisiana Health Secretary Rebekah Gee wrote a letter Monday to Sen. Bill Cassidy (R-LA) to share her "deep concerns" with the repeal and replace bill that he's helped to craft.... As Senate Republicans jockey to get 50 votes to support the bill, Gee warned Cassidy that his plan to cut Medicaid expansion would jeopardize coverage for 433,000 Louisiana residents, a move that would be a "detrimental step backwards for Louisiana."

What's more, Cassidy isn't alone on this front.

There are four main co-sponsors of the current GOP plan, and while Cassidy's constituents would certainly take a severe hit as a result of his own legislation, the same is true of Sen. Dean Heller (R) of Nevada, another member of the quartet. Vox noted yesterday that Nevada, one of 31 states to embrace Medicaid expansion through the Affordable Care Act, also stands to lose millions if Heller's bill becomes law.

I'm reminded of an interview Donald Trump did in March, when Fox News' Tucker Carlson reminded the president that his health care plan would punish "counties that voted for you" more than areas that didn't.

"Oh, I know," Trump replied. "I know."

Taking deliberate steps to hurt your own supporters and constituents is a hard thing to understand in a democratic system, and yet, here we are.