Today’s must-read is on a subject we’ve been following pretty closely here: what happens if the Supreme Court in its review of King v. Burwell strikes down the “premium tax credit” insurance purchasing subsidies provided in the Affordable Care Act in the 36 states that did not set up their own purchasing exchanges. It’s not that there’s anything inherently complicated about the “fix.” Congress could resolve the problem in about a day with a one- or two-sentence amendment to ACA that made plain what the bill’s sponsor’s clearly intended all along: the subsidies are available in all 50 states.
The problem, of course, is that Republicans cannot support a simple “fix” after years of treating Obamacare as a socialistic abomination unto the Lord. But if they do nothing, millions of people, many of them Republican voters (particularly since Republican-run states were the most likely to reject the “complicity” in Obamacare that setting up an exchange supposedly involve), would suffer higher insurance premiums and terrible things could happen to the entire health insurance market-place, and they could be quite rightly blamed. Worse yet, it is widely perceived that the odds of a SCOTUS decision decimating the subsidies depends on the degree of preparation for it by Congress, which now means the Republican Party.
So Republicans are casting about for a measure that would turn a “fix” into a policy victory, and as Sahil Kapur of TPM found by talking to a lot of them, they are not close to a consensus.
“It’s an opportunity that we’ve failed at for two decades. We’ve not been particularly close to being on the same page on this subject for two decades,” said a congressional Republican health policy aide who was granted anonymity to speak candidly. “So this idea — we’re ready to go? Actually no, we’re not…”
Thomas Miller, a health policy expert at the American Enterprise Institute, said Republicans are unlikely to have a “fully formed” plan before the ruling. He said it would be a slow burn — they may have to “let off some steam” with repeal votes before they vote on serious solutions.
“Certainly there are cross-pressures and impulses within just the Republican ranks on this,” he said. “There are issues that are not going to be fleshed out — a consensus is not going to be reached in advance of the King decision.”
But Miller said it’s important to build support for a set of proposals ahead of the ruling and have legislation on the shelf that “gets the job done in a period of several weeks in late June to early July.” He proposed three broad ideas to fill the hole the Supreme Court might create: a tax-credit mechanism (which could be income-sensitive, age-adjusted, or a flat dollar amount), block grants to states, and reforms to the exchanges. None will be easy to secure support for.
And that’s just at the elite level. No one at this point in the GOP is addressing how they deal with the ecstatic reaction of their party’s conservative activist base if and when the news blares out on Fox that SCOTUS has landed a lethal spear in the hide of the Great White Whale. Just yesterday polling data came out showing Republican rank-and-file opposed the idea of Congress doing anything to “repair” Obamacare. Ya think maybe the already difficult process of agreeing on a “fix” might be complicated a bit more by the shrieks of “NO! NO! NO!” from every Republican who has been told again and again that the Affordable Care Act is the worst thing to happen to America in living memory? Is it possible a Republican presidential candidate or three would exploit the situation by starting a crusade to destroy any GOP member of Congress who even thinks about “fixing” Obamacare?
Yeah, Republicans have a ways to go on this issue, and not just in terms of reaching the kind of agreement on a health care policy approach that has eluded them for so very long.