“I can’t have it both ways,” Sen. Lindsey Graham said. “I mean, if you want to have a single-payer health care system, be my guest.” | Jim Watson/Getty Images Conservatives fear Obamacare repeal bill could open door to single-payer care

Conservatives pressing for the repeal of Obamacare want to give states the right to enact whatever health care plan they want — as long as it's not government-run health care.

The Graham-Cassidy health care bill would give states — instead of the federal government — significant freedom over how they operate their health care programs, generally with much less money than they get today. In theory, that means a liberal-leaning state could pursue a single-payer system or government-run insurance plan.


Heritage Action is urging congressional Republicans to block that possibility. The conservative policy advocacy group is asking the GOP to remove three provisions in Graham-Cassidy that would allow states to use their funding to pay medical providers directly, contract with managed care plans for specific groups of people and expand their Medicaid programs.

The changes would “ensure states do not use the new block grant funding to force individuals into restrictive, government-run health care programs,” Heritage Action wrote in a memo.

Sen. John Kennedy (R-La.) this week expressed a similar concern.

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But Sen. Lindsey Graham (R-S.C.), one of the bill’s authors, says Republicans can’t laud states' rights while putting restrictions on federalism.

“I can’t have it both ways,” he said. “I mean, if you want to have a single-payer health care system, be my guest.”

Other conservatives, such as Sen. Mike Lee (R-Utah) have sent similar invitations to blue states.

In recent years, several states with liberal governors and legislatures have raised the prospect of setting up a single-payer health care system. But so far, they’ve run into trouble with funding and other logistics.

Under Graham-Cassidy, the secretary of Health and Human Services would have significant discretion to approve state waiver requests, meaning that a future Democratic administration could help approve a single-payer health system.