If you want a good basic understanding of what would happen immediately if SCOTUS strikes down Obamacare subsidies for people living in states that did not create their own insurance purchasing exchanges, read James Surowiecki’s piece at the New Yorker on the subject. He’s very convincing in maintaining that in cheerleading for a legal attack on subsidies the GOP may have set a trap for itself:
[T]he disappearance of subsidies is going to put governors and legislatures in states that haven’t established their own exchanges (nearly every red state) in a very difficult position. After all, their refusal—mostly politically motivated—to establish those exchanges will be the reason that their citizens lose subsidies, even as people in states like California and New York are reaping all the benefits of the law. The state legislatures will also, in effect, be responsible for insurance suddenly becoming far more expensive for millions of people. Finally, the politicians will also be putting a severe dent in the bottom line of insurance companies in their state, since the absence of subsidies guarantees that insurance companies are going to lose the customers they want (healthy people with low health-care costs) and get stuck with those they don’t (sick people whose health-care costs are sure to dwarf their premium payments).
I suspect more and more Republicans each day will begin to grasp the grief a “win” in SCOTUS will create for them. But it’s not easy for any of them to talk about “fixing” Obamacare, easy as it would be at either the federal or state level. And more importantly from a political point of view, announcement of a decision reported as “a major blow to Obamacare” will likely provoke a paroxysm of joy among conservative activists and rank-and-file that will be difficult to reverse.
Perhaps behind the scenes conservatives are beginning to plan an education campaign to explain to The Troops via Fox News or other “trusted” sources why they can’t just let the subsidies die. Last week I noted that Ramesh Ponnuru had begun talking about Republicans agreeing to fix the subsidy problem while pivoting (presumably as part of some national “deal”) rapidly to an Obamacare “replacement.” But he didn’t sound terribly confident about selling this strategy to the GOP. Since we’re unlikely to find out where SCOTUS is going until June, there is time for sober reflection on the consequences of taking away the subsidies among a constituency that’s a lot more likely to include a lot of Republican voters than the subjects of a Medicaid expansion. The question is whether it can be effectively and quickly communicated to people who have been told since 2010 that the Affordable Care Act is the work of the devil.
