Looking at a Post-King v. Burwell World With More Precision

Via the Scholars Strategy Network, Harvard’s Theda Skocpol and the University of Minnesota’s Lawrence Jacobs have prepared a succinct but comprehensive analysis of what, exactly, would happen if the Supreme Court decides for the plaintiffs in King v. Burwell. It’s not as dreadful a scenario as you might imagine–unless you are a Republican politician beginning to understand with horror the position it might put you in.

Skocpol and Jacobs note that the major national policy changes–most notably bans on discrimination against people with pre-existing conditions, and limitations on price discrimination against the old and the sick–would stay in place. And in states that either already have or could be expected to quickly adopt their own exchanges, life would go on as before:

Overall, from half to three-fifths of Americans reside in states where subsidies probably or certainly would not be discontinued. These states almost all have effectively functioning marketplaces where growing numbers of insurers are offering competitively priced plans and making solid profits.

The rest of the states are for the most part governed by conservative Republicans, and aside from the immediate distress of people losing subsidies and probably insurance altogether, Obamacare waivers that adapted exchanges for use by the entire Medicaid population would be endangered. Worst of all, the ensuing debate will focus on the real linchpin of GOP resistance to Obamacare, which is equitable treatment of old and sick people. But as Skocpol and Jacobs note, that is precisely the most popular element of the Affordable Care Act.

So far, Republicans have been able to denounce “ObamaCare” without discussing popular specifics. But that strategy will collapse if the Supreme Court threatens profits and benefits already in place – and a new Republican Party strategy may prove hard to devise amid splits between ultra-conservatives eager to destroy the health reform law and pragmatists seeking to modify and live with it.

Yep, that about sums it up. Conservatives may be publicly asking SCOTUS to toss a spear into the Great White Whale of Obamacare. But privately they may be praying for a reprieve from waves of discontent that might capsize their entire ship.

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.