The lion’s share of tributes pouring in for Lindsey Graham, who died unexpectedly over the weekend at 71, will rightly focus on his commitment to bolstering American national security. But there’s another aspect of his legacy that warrants celebration and reflection.

In between his crusades to seat President Donald Trump’s nominees and defend democracy abroad, the late senator from South Carolina led one of the last true efforts to fix American health care. With his death, the last of the Republican health care reformers is gone. We ought to reflect on this fact as we honor his life of public service.

Graham was one of the earliest and most vocal opponents of the Affordable Care Act. “A government-run, government-controlled system will increase costs, reduce patient choice, and eventually lead to rationing of care,” Graham said after President Barack Obama unveiled his signature healthcare proposal in 2009. A year later, Graham lamented the damage Obamacare’s passage had done to American health care and the legislative process, saying, “the well has been poisoned.”

In the years that followed, Graham never gave up the fight. But unlike many of his colleagues, he did more than occasionally call for “repeal and replace.” In 2017, a succession of GOP reform bills fell in rapid succession, ending when Graham’s friend, Senator John McCain, famously gave a “thumbs down” to the Health Care Freedom Act of 2017.

Undeterred, Graham joined with Louisiana Senator Bill Cassidy to introduce an amendment to a budget reconciliation bill that would come to be known, colloquially, as “Graham-Cassidy.” The package would have taken all the money that Obamacare allocated for premium credits and Medicaid expansion — $1.2 trillion over six years — and distributed it to the states through block grants.

“The Graham-Cassidy plan is built on the premise that the federal government should remove itself from many of the difficult policy decisions concerning how health insurance is subsidized and regulated,” the American Enterprise Institute’s James Capretta and Joseph Antos wrote at the time. The bill, they said, “would provide substantial flexibility to the states to design entirely different ways of subsidizing and regulating health insurance in the individual market.”

The bill would have saved taxpayer money while giving more resources directly to states. It would have helped lawmakers crack down on fraud. And, perhaps most shockingly in retrospect, it would have guaranteed access to affordable coverage for Americans with pre-existing conditions. Graham-Cassidy would have allowed every state to innovate and design competitive insurance marketplaces that fit their unique needs, essentially removing Obamacare’s inefficiencies and problems without hurting the safety net.

There was a lot more to Graham-Cassidy — it repealed the individual mandate, capped federal Medicaid contributions, among other things — but the crux of the bill was returning control to the states. Today we tend to dismiss this kind of policy as a cop-out. But at the time, returning control to the states was seen on the Right as the best way to fix Obamacare. Graham was no fan of the ACA, as we saw. But he understood that a straight repeal was likely impossible, and instead focused his efforts on reform, giving relief to Americans priced out of the individual market and giving freedom to the states.

Graham was one of the last, but certainly not the only, Republican who affixed his name to a smart healthcare reform bill. Republican Senators Tom Coburn (OK), Richard Burr (NC), and Orrin Hatch (Utah) introduced their eponymous reform bill in 2014. When Coburn retired from the Senate later that year, Congressman Fred Upton (MI) took his spot on the legislation.

Neither version of the bill passed, and all of its sponsors have moved on. Coburn died in 2020, and Hatch followed two years later. Burr retired in 2022, Upton in 2023. And Cassidy lost his primary just this year, in a large part because he continued pushing nuanced but increasingly unpopular health care policies well into President Trump’s second term.

Republicans have yet to replace Graham and his fellow reformers. McCain’s no vote on Obamacare repeal temporarily chilled Republican reform efforts. Shortly thereafter, the coronavirus pandemic and subsequent election of Joe Biden would fundamentally reshape American health policy for the worse. The Republican Party, long willing to push for entitlement reform, fell captive to populist members and leaders who pledged to never cut Medicare and Medicaid. The ongoing vaccine debate has made hating the pharmaceutical industry a rare area of bipartisan agreement, a change that has all but ended any push for innovation or reform.

The result is that no one wants to fix health care anymore. Republicans are scared to upset the status quo, and Democrats, realizing that they’ve essentially won the war, have mostly pumped the brakes on their more radical attempts to push American health care to the Left, perhaps the last thing that would have motivated Republicans to make another push for reform.

Graham’s death did not cause or hasten any of these developments. But it is a stark reminder of what Republicans have lost, in the Senate and elsewhere. Graham was one of the last senators who consistently acted on the courage of his convictions, who was willing to do the complicated, ugly, and often unpopular work of real legislating and serious policymaking. His party changed and public opinion turned, but Lindsey Graham never stopped fighting for what he knew to be right and what he knew was best for the American people. May his legacy inspire other lawmakers to pick up his mantle.