Republicans are sending mixed messages on federalism. On “gag clauses,” all Republicans save two voted on Monday to intrude on states’ handling of pharmaceutical negotiations — even though a majority of states have passed legislation on this topic, including 15 just this year. And on “surprise billing,” Sen. Bill Cassidy — sponsor of the Graham-Cassidy legislation — apparently thinks states are smart enough to handle $1.2 trillion in Obamacare spending, yet are too stupid to craft policy regarding out-of-network medical bills.