"If we could get the money back to the states, Democratic policies would be tested against our policies," Graham said. "This scares the hell out of the Democrats. This is what 2020 is about." So called "States Rights" have always proven to be a disaster when it comes to anything that involves broad social policy which benefit the population of the United States at large. Think Social Security being allowed to be disseminated through; "States Rights." Disaster. Just the Affordable Care Act has had its fair share of challenges with states suing to not have to expand Medicaid which is a disaster for their own constituents for ideological purposes. Think: Killing our own constituents because we don't want to be forced to provide care to our most vulnerable citizenry. To date, 37 states (including DC) have adopted the Medicaid expansion and 14 states have not adopted the expansion. Even Republican States have adopted the Medicaid Expansion because of FMAP which is the Federal medical assistance percentage given to states based on a predefined formula. My own State's FMAP was 65% prior to the passage of ACA. The newly eligible FMAP (described in section 1905(y)(1) of the Act) is 100 percent in calendar years 2014-2016, 95 percent in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019, and 90 percent in calendar years 2020 and beyond. So imagine getting a Federal match of 90% versus 65% and you begin to see the ramifications for State's budgets and what can be achieved for its constituency. You can put together Federally Qualified Health Clinics, hospitals are reimbursed instead of providing uncompensated care (many rural hospitals were going under ad closing as they couldn't put up with providing free care any longer), etc. As a former Healthcare Executive I have written about what the repeal means. It is disastrous and Lyndsay Graham is a fool who is being selfish in regards to believing he will get more money in to South Carolina as a result of taking money away from higher population states like California. What has weakened the Affordable Care Act is the intentional sabotaging of it with Republicans ever since it was passed. This was done through the elimination of the individual mandate, sabotaging publication of enrollments and providing shorter enrollment times, defunding assistance in helping people enroll, etc. The other thing which has caused uncertainty and a lack of stability in pricing is the constant threats to the program in the several years since its passage. If anything the Affordable Care Act should have been strengthened and added to since its inception as programs like this which benefit our population as a whole should be added to rather than subtracted from. Think Social Security since its inception added Medicare, Disability benefits, survivor's benefits and other enhancements since. The real issue that sticks in the craw of Republicans is they wanted ACA repealed prior to it becoming popular with the American people. That horse has been let out of the barn and yet they still want it repealed. They always try to do this with Social Security, Medicare & Medicaid as they have gotten so used to a rich degree of socialism for the rich and strict capitalism for the rest of us. The ACA is just another good benefit that they did not want to develop an institutional foothold in to the fabric of our society and this latest court challenge may finally have the impact of destroying the ACA and allowing us to go back to pans which provide little benefit and bankrupt Americans who should have the right of decent healthcare like many other countries already do.