How much do congressional Republicans hate Obamacare? How determined are they to see it fail?
We may soon find out. For the first time, a constituency group to whom the GOP normally pays close attention–religious institutions–is asking for a legislative “fix” of the Affordable Care Act to make it work as intended. If the recent past is any indication, conservatives will resist any such effort on grounds that Obamacare must be repealed root and branch, not repaired or reformed.
Months of outreach to Republican Senate offices by religious leaders have yielded no official GOP support to an appeal from a broad coalition of religious denominations to ensure that church-sponsored health plans can participate in the ACA’s health insurance exchanges. Worse yet, from a partisan Republican point of view, two Democratic senators, Mark Pryor and Chris Coons, were the first responders to this call, introducing legislation late last week. Pryor is widely viewed as the GOP’s number one senatorial target in 2014.
Without the requested “fix,” as many as one million clergy members and church employees now enrolled in church-sponsored health plans could soon face the choice of leaving these plans (designed to meet their unique needs, such as the frequent reassignment of clergy across state lines) or losing access to the tax subsidies provided by the ACA to help lower-to-middle income Americans purchase insurance.
Observers generally agree that the exclusion of church health plans from eligibility for the exchanges, which occurred because they do not sell policies to the general public, was an oversight caused by staffers scrambling to draft bill language under tight deadlines. Because employees of religious institutions are usually paid modestly, many will qualify for subsidies made available on a sliding scale to families earning up to 400 percent of the federal poverty level. But the subsidies can only be used to purchase insurance from the exchanges.
Rodney Miller, Executive Officer-Special Counsel at GuideStone Financial Services, the provider of the Southern Baptist Convention’s church health plan, told the Washington Monthly that the purpose of the Pryor-Coons bill is “basic fairness.”
Without the “fix,” he said, clergy would be “forced out” of church plans to access the tax credits they would otherwise be entitled to receive under the law. And that in turn could threaten the viability of the plans themselves. Among the supporters of the Pryor-Coons effort are the Southern Baptist Convention, the United Methodist Church, the Episcopal Church, and the Presbyterian Church. The legislation also enjoys the backing of the Church Alliance, a coalition of religious organizations represented by the firm K&L Gates.
Since the issue isn’t cost but simply whether the subsidies will flow to existing church-based plans or alternative insurers, supporters of the “fix” regard it as non-controversial. “We had hoped for it to be bipartisan,” said Barbara A. Boigegrain, Chief Executive Officer of the pensions and benefits board for the United Methodist Church, in an interview with the Washington Monthly.
Religious groups have sought this fix since at least 2011, and several sources say that at least half a dozen Republican Senate offices have been approached for their support, including Sens. Marco Rubio, Lamar Alexander and Dan Coats, but so far to no avail. Emails and calls by the Washington Monthly to Sen. Rubio’s and Alexander’s offices were not returned.
Instead, Republicans seem to be signaling their determination to bring down the Great White Whale of Obamacare at almost any cost to potential beneficiaries.
Most obvious, of course, has been the passionate resistance of many Republican governors and state legislative leaders to the Medicaid expansion provided for by the Affordable Care Act, which could perversely deny millions of low-income citizens access both to Medicaid and to the purchasing subsidies available to those with incomes above the federal poverty level. In Congress, House Speaker John Boehner and Senate Republican leader Mitch McConnell have refused to submit nominees to serve on the Individual Payment Advisory Board created by the ACA, effectively blocking its launch, on grounds that anything other than the “full repeal of the Affordable Care Act” was acceptable. And House GOP leaders recently abandoned an initiative by House Majority Leader Eric Cantor to add funding for a high-risk pool for people denied coverage for pre-existing conditions (the preferred Republican alternative to the ACA’s flat ban on such coverage denials) after conservative objections to “fixing” Obamacare.
So Senate Republicans will soon face a test of commitments–particularly those with close ties to the Christian Right. At last week’s annual meeting of the largest conservative evangelical denomination, the Southern Baptist Convention, clergy were informed of this issue. Religious leaders are beginning to lobby Congress in support of the Pryor-Coons bill this week. It will be fascinating to see if this sort of pressure can shake the GOP’s determination to pursue the unconditional repeal of Obamacare to hell and back.