Perhaps it’s a sort of post-election “OMG, it just keeps getting worse” syndrome for progressives, but the Supreme Court’s decision to grant cert to the challenge to the Affordable Care Act’s health insurance purchasing subsidies in the 36 states that did not set up their own exchanges may be getting more attention on the Left than the Right. The big argument is whether this scenario could force Republicans to participate in a “fix” (either in Congress, by making the tiny changes necessary to make it clear the subsidies are indeed available to people using the federal exchanges) or in the states (where existing federal exchange arrangements could be rechristened as “state exchanges” clearly eligible for the subsidies).
Some progressives are optimistic that Republicans could be forced to eat their words, since the subsidy beneficiaries aren’t mainly those people at issue with the Medicaid expansion. Here’s how Simon Maloy laid out their dilemma at Salon:
The biggest political challenge facing the GOP is the fact that “repealing” or otherwise damaging the Affordable Care Act, while ideologically satisfying, carries with it some very real consequences. The states that opted not to create their own health exchanges – the states that would lose their health insurance subsidies if SCOTUS rules against the government – are mostly Republican-governed states. The sudden unavailability of those tax credits would mean that a lot of newly insured people in those states would no longer be able to afford their health coverage. They will expect their elected officials to do something to mitigate the damage, which would be catastrophic. Close to 5 million people across the country would see their health insurance costs spike.
I dunno. It kind of depends on how such a SCOTUS decision would be implemented. It probably won’t just be the subsidies evaporating leaving the rest of the Obamacare structure in place. As Greg Sargent explained in an excellent immediate reaction to the decision, the federal exchanges will probably collapse with insurers withdrawing. Maybe that would force Congress or the states to act, or maybe those losing subsidies could be in a position to go back to buying whatever crappy insurance they were getting before 2010, at lower–if rapidly increasing–premiums.
I’ve heard some talk of a scenario by which congressional Republicans would react to a SCOTUS decision killing the subsidies by offering a quick “fix” on condition that Obama put away the veto pen on one of those Obamacare concessions they’ve already discussed trying to push next year, like repealing the medical device tax or killing or modifying the employer mandate.
Perhaps that could happen, but color me skeptical. The one thing we know for sure is that there would be an explosion of joy, and quite literally dancing in the streets, in conservative precincts if the news breaks in June that “the Supreme Court has dealt a fatal blow to Obamacare.” Unless “the base” is carefully tutored in the weeks and months before a decision comes out that Republicans cannot or should not just let it take effect–by whom I don’t know (Fox News? The Republican Governors’ Association?)–then any kind of “fixes,” nationally or in the states, will be politically perilous for Republicans. That’s even more true of a congressional “fix” linked to some tenth-of-a-loaf concession on Obamacare. Can you imagine what a boon such a development would be to a Ted Cruz presidential campaign? The Establishment has sold us out on the defining issue of our era, he would say, without getting into the messy details of what he’d do for the people losing subsidies but regaining their “freedom.”
I suspect a lot of the optimism about a Republican “fix” flows from the belief that the main GOP objection to Obamacare involves the price of premiums (just as a lot of the same people thought the generous federal match of the Medicaid expansion would make it a no-brainer for all states, even those run by Republicans). That’s an important talking point, to be sure, but for “the base” it’s much more about the “slavery” of the individual mandate and the notion that this is the entitlement that carries America over the tipping point where it will now descend quickly to a totalitarian dystopia. The idea that Obamacare subsidies are a “bribe” to encourage people to go along with their enslavement is deeply rooted on the Right. I have a hard time imagining conservatives agreeing to save them.