Politico foresees “political peril for the GOP” if the hastily constructed and deeply unpopular Affordable Care Act is gutted by the Supreme Court in the summer. That’s counterintuitive, but they make a strong case for why the Republican coalition could be destabilized by a decision in King v. Burwell that dismantles a key provision of the Affordable Care Act.
“They don’t agree on what alternative, if any, their party should offer to President Barack Obama’s signature health care law,” Politico reported. “But the issue is taking on new urgency for the GOP congressional leaders as the Court takes up a case that could leave more than 5 million people without Obamacare’s crucial subsidies.”
This is not an inaccurate observation. Many in the GOP’s conservative base will be eager to see both their party and their preferred presidential candidate replace Obamacare with nothing at all. While most in the Republican political class do not see this as a viable option, some are supporting replacement proposals that dramatically reduce the scope of the impact of federal health care reform. Louisiana Gov. Bobby Jindal has backed a proposal that does away with offering tax credits to Americans who receive employer-provided insurance. Instead, his plan would offer a deduction that allows everyone to buy health coverage on the individual market.
“The great flaw in Jindal’s plan is that it would cause millions of people to lose their coverage,” Ramesh Ponnuru observed. “Deductions are more valuable to those in high tax brackets, and they wouldn’t provide much help for the lower-income people whom Obamacare allowed to enroll in Medicaid.”
Republicans like Reps. Paul Ryan (R-WI), Fred Upton (R-MI), and John Klein (R-MN) and Sens. Lamar Alexander (R-TN), Orrin Hatch (R-UT), and John Barrasso (R-WY) are all working on a Republican alternative to the ACA and, Time Magazine reported, are expected to oppose restoring federal subsidies to the ACA if the Supreme Court strikes them down.
While there is a lot of disagreement about just how Republicans will go about replacing the ACA, the increased tempo of the debate over the issue suggests that Obamacare has never been more vulnerable. All things considered, a disagreement over just how to repeal and replace the onerous health care reform law is a good problem for Republicans to have. But The Hill’s A.B. Stoddard suggests that the GOP will not have it that easy. She noted that, despite the ACA’s unpopularity, the general public will not be joining with conservatives dancing in the streets if the Supreme Court prevents millions of Americans from accessing subsidized health insurance.
When the high court rules this spring in King v. Burwell, even a decision that would invalidate subsidies to cover health insurance in 37 states where the federal government operates exchanges may not necessarily spell doom for those subsidies or the system at all.
Republicans are already anticipating President Obama’s response would be an executive order directing federal marketplaces to immediately belong to those states or a bill asking Congress to do the same, or at least to extend the subsidies in some form. Somewhere between 5 million and 7 million people, many from Republicans states that refused to start exchanges, will be at risk of price hikes that could eventually torpedo the entire law. The GOP is scrambling for an appropriate response as a new Kaiser Family Foundation poll shows, in the case of a ruling against the law, that 64 percent of Americans want Congress to extend subsidies in affected states — including 40 percent of Republican respondents.
Over time, ObamaCare has morphed into a zombie Republicans cannot extinguish.
It is no doubt a political opportunity for Democrats if the Court guts the law and Republicans refuse to restore access to subsidized care to millions of low-income Americans. Stoddard predicts that congressional Republicans might prefer to extend subsidies that would sunset in 2017 and allow the voters to determine the law’s future at the ballot box in 2016. The voters’ mandate will determine whether or not the law’s subsidies are restored or whether a conservative reform proposal will replace the Affordable Care Act.
In any case, Stoddard suggested that the demands of the GOP’s most conservative elements are at odds with those of the general public. She observed that the fact that three House Republicans refused to join their colleagues in voting to repeal the ACA this week suggests that there will be resistance to doing away with the law altogether from Republicans who represent purple districts or states. A diverse and ideologically heterogeneous coalition is a consequence of having the largest congressional majorities in a half-century.
Ultimately, Stoddard and Ponnuru are correct: The GOP will have to settle on an alternative to the ACA that does not rob millions of the coverage on which they depend. To suggest that low-income Americans will and should lose the coverage they have come to expect would be politically poisonous. That is a position that might generate enthusiasm in the Republican presidential primary but, much like “self-deportation,” it will sap Republicans of public support when it comes time to run a general election campaign.
The ACA is vulnerable, but it will not be the Supreme Court that delivers the final blow. Only a conservative repeal and replacement proposal that enjoys broad, popular support will bury Obamacare forever.