How Ryan Plans to Undermine Obamacare

There has been a lot of talk lately about the challenge Trump and Republicans face in meeting their promise to repeal Obamacare. The argument has been that, without a plan to replace ACA (which Republicans haven’t been able to agree on), to simply repeal it means that approximately 20 million people will lose the insurance they’ve signed up for via the exchanges. There are, of course, other challenges, such as how to make the provision that eliminated the ability to refuse coverage for those with pre-existing conditions affordable without the mandate and subsidies. But let’s leave those for another day to focus on what is likely to be Speaker Paul Ryan’s plan for undermining the exchanges.

Tierney Sneed reports that House Republicans are reviewing their plans about whether or not to continue a lawsuit they filed against Obamacare known as House vs Burwell. To review what that is about, it is important to know that the law included several provisions to make insurance affordable on the exchanges. One of those is that, for enrollees who earn between 100 and 250 percent of the federal poverty line, the government provides cost-sharing subsidies to insurance companies in order to limit out-of-pocket expenses. These are separate from the subsidies individuals receive directly based on their income.

From the time the exchanges were implemented, House Republicans have refused to appropriate the money for these cost-sharing subsidies. The Obama administration found a work-around for that in tying them to the tax credits which are available to enrollees. In House vs Burwell, Republicans challenged that work-around and won a ruling from a DC Circuit Court Judge. Payment of the subsidies has continued awaiting appeal by the administration.

Here is what Sneed reported:

House Republicans led by Speaker Paul Ryan filed a court document Monday evening asking an appeals court to pause the proceedings in the case, known as House v. Burwell. A senior GOP aide said the move was made to give the new administration the opportunity to weigh how to handle the lawsuit.

While Sneed suggests that how the Trump administration handles this will tell us a lot about how they plan to proceed on repealing Obamacare, the signal has already been sent. Rather than risk losing the case, what is likely to happen is that the president-elect will simply drop the appeal and stop paying the subsidies – claiming the circuit court judge has already deemed them illegal. That means that insurance companies will face a decision about whether or not to significantly raise premiums or get out of the exchanges altogether…at which point Republicans will claim that they failed.

This is classic Republicanism – especially the kind we’ve seen from Speaker Paul Ryan. What it amounts to is that they do what they can to ensure the failure of government programs and then claim that their condemnation of those programs was correct. It is similar to what Ryan is likely to try to do with Medicare. The plan is to remove the Obamacare cost savings to that program and then claim that Medicare is going broke and needs to be privatized.

This is a deeply dishonest way to govern. But I suspect that someone like Ryan is aware of the fact that most Americans won’t dig deep enough into their shenanigans to blame them for undermining successful programs rather than working to improve their functioning. In the end, if the Speaker was so confident that the American people would support his Randian views, he could be honest and tell us what he wants to do. Instead he engages in this kind of subterfuge because he thinks he can fool us.

Nancy LeTourneau

Nancy LeTourneau is a contributing writer for the Washington Monthly.