Republicans should plan for post-Obamacare world
By Ramesh Ponnuru,
Bloomberg View
WASHINGTON - Millions of Americans could find their health insurance plans endangered if the Supreme Court rules this summer that President Barack Obama's administration has broken the law in subsidizing them. The administration created this problem by pushing through a poorly written statute and lawlessly implementing it. But congressional Republicans nonetheless should step up and solve the problem - and they should do it in a way that hastens the end of Obamacare.
The Affordable Care Act lets subsidies flow to insurance plans purchased on exchanges established by state governments. Since most states haven't set up exchanges, following the law would have required limiting the subsidies geographically. The administration decided to offer them more widely, to include plans purchased on federal exchanges in states that declined to establish their own. If the Supreme Court decides to reinstate the law's limits, millions of people whose plans are subsidized will suddenly face much higher premiums. And if they drop their coverage, it could cause premiums to rise for those who are left on the exchange, even people whose own plans aren't subsidized.
Republicans could respond to this situation by saying it's Obama's fault and not their problem. But that would be a pretty callous reaction, and it probably wouldn't be politically sustainable. A new poll from the Kaiser Family Foundation shows that if the court restricts the subsidies, 64 percent of people think Congress should "pass a law so that people in all states can be eligible for financial help from the government to buy health insurance." Democrats would present a united front calling for quick fixes: The recalcitrant states could set up exchanges or deem the federal exchange for their residents to be "state-established"; Congress could pass a short bill blessing the subsidies everywhere.
Acceding to such demands, however, would present its own disadvantages. Republicans would have to expand the reach of Obamacare right after the court had shrunk it, entrenching a model of health-care policy they consider bad for the country and enraging many of their supporters. Because of the way Obamacare is written, the ruling would end the employer mandate and limit the reach of the individual mandate in the affected states. Going along with the Democrats would mean voting for these especially unpopular features of Obamacare. If the only alternatives are doing nothing or effectively reversing the court's decision, Republicans will split over which to choose and fight each other about it.
But there are other alternatives. Republicans could, for example, offer to authorize the subsidies everywhere, but only through the end of this presidency and in return for some changes to the law. Or they could offer a health-insurance alternative of their own that enables the people affected to get affordable coverage.
One possible solution would be to allow states to opt out of Obamacar and into something better, freeing them from the law's regulations. That would create a safe exit ramp from Obamacare, protecting people from losing their coverage when Obamacare's subsidies end. Opponents of the law would no longer have to choose between leaving people without insurance and expanding a bad health-care policy.
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