The Obamacare “Exit Ramp”

Vox‘s Sarah Kliff listened to a presentation by reformicon journalist Ramesh Ponnuru and came away convinced that most of the options for Republicans if King v. Burwell‘s plaintiffs win in the Supreme Court are either unworkable or pretty bad for the GOP. The exception, she says, may be what Ponnuru calls an “exit ramp from Obamacare:”

This is the option that Ponnuru personally favors: a deal where states, particularly those using, would be given the right to opt-out of big parts of the insurance expansion. This could include things like getting rid of the individual and employer mandates, the requirements that insurers cover a large set of benefits, and allowing insurers to once again reject consumers who have pre-existing conditions.

This deal would involve some sort of transition period, maybe a year or two, as to make the change less disruptive for those using Obamacare benefits.

Ponnuru talks about this as a distinct option, although it seems pretty similar to the idea of “striking a deal” with Obama — and, as a result of that, faces the same obstacles. The White House has been pretty firm in not allowing states to pick and choose which parts of Obamacare they want. There are already state innovation waivers in Obamacare — which let states dodge numerous health reform requirements, if they meet a set of conditions — and those waivers seem to be as far as the White House is willing to go in this space.

While a negative Supreme Court decision would certainly be bad for the administration, it’s hard to see it being bad enough for the president to reconsider that stance. Ponnuru acknowledges this challenge and the fact that it’s “very hard to see the Democrats going for this.”

I suppose Republicans could come up with some sort of “super-waiver” that universalizes concessions already made by the administration in particular states in exchange for acceptance of the Medicaid expansion. But it’s doubtful the administration would make the concessions for anything less than Medicaid expansion, and even more doubtful Republicans could agree on a list of concessions–particularly with vociferous voices from “the base” in the background demanding that they let the damaged Great While Whale die. The other problem, of course, is that a state-by-state approach would concentrate the damage in states disproportionately represented by Republicans. Meanwhile, those freeloaders in the blue states would keep on leeching away everybody’s federal tax dollars via subsidies. Can’t have that, can we?

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Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.