U.S. Sen. Bill Cassidy, right, speaks with attendee Jerry Castille during a town hall meeting Friday, February 24, 2017, at City Hall in Breaux Bridge, La.

Advocate staff photo by LESLIE WESTBROOK

The health care bill from the GOP congressional leadership now supported by President Donald Trump is ostensibly aimed at following through on what Republicans promised in last year's campaign — namely, the repeal of Obamacare.

But as with any legislation, the devil is in the details. We hope that members of Louisiana’s congressional delegation keep in mind what's at stake for the state as lawmakers revisit the Affordable Care Act, aka “Obamacare,” on Capitol Hill.

With the exception of Democrat Cedric Richmond of New Orleans, the delegation is all Republican, and all the GOP members at one point or another have pledged themselves to repeal of the health care law passed under President Barack Obama.

But lawmakers from Louisiana and elsewhere should remember what history could well record as Obamacare's fatal flaw: its passage without a bipartisan consensus.

That allowed a measure with huge practical implications for individuals and families to become a political football, subject to volatile changes with the next election cycle. Health care's central role in family and business life underscores the importance of advancing reforms that promote stability and predictability. Instead, the partisan rancor surrounding Obamacare has resulted in health care roulette, with households and employers essentially spinning a wheel each year to estimate benefits and costs. 

Trump's victory means that those “repeal and replace” changes will probably be of greater scope, but whatever emerges from Capitol Hill needs buy-in from both Republicans and Democrats.

Such a consensus must begin, we think, with a frank assessment of how any health care bill will affect Medicaid assistance for the working poor, an issue of special gravity in Louisiana. The state budget, tenuously balanced ever year, is predicated on Medicaid expansion continuing on the generous terms of the Obama law. If that goes away, the poor will suffer most, but the subsequent tide of red ink at the State Capitol would impact higher education and other state services that touch every resident of Louisiana, regardless of income.

A key voice in these Capitol Hill debates may be Louisiana's U.S. Sen. Bill Cassidy, who is a veteran of health care in the LSU hospital system in Baton Rouge. He recently introduced legislation that would give states more flexibility to experiment with alternatives to Obamacare while providing a range of federal support to help people get insurance. As he points out in a new opinion piece for The Hill, the uninsured are paid for only in part by U.S. government funds, and “society pays the rest of the bill for the uninsured when hospitals shift the remaining cost to the privately insured (typically employers and their employees) who pay higher premiums to underwrite the ‘free care’ the uninsured receive."

Cassidy's remarks bear a basic but compelling reminder that the benefits — and costs — of health care are borne by everyone, regardless of party or station in life. That is why the pie-in-the-sky promises of campaign season must now give way to the practical give-and-take of compromise. Short of that, last year's hopes for health care reform will be dead on arrival.