Surely President Barack Obama hoped that his suggestion that asthma rates have increased as a result of climate change would be the newsiest nugget to emerge from his interview with CNN’s Dr. Sanjay Gupta. That is apparently the latest front in the perennial quest to make the issue of global warming both relatable and pressing for the broader public, and Dr. Gupta lent that claim substantial credence. But the most compelling bit that Gupta drew out of the president during their exclusive interview was Obama’s admission that there is no plan to move forward if the Supreme Court rules against the government in King v. Burwell and strips illegal federal subsidies from millions of Affordable Care Act beneficiaries.
Gupta appeared to be shocked when he asked the president about his proposed way forward if his administration finds itself on the wrong end of a Supreme Court ruling in June. The CNN correspondent seemed surprised by Obama’s boilerplate condemnation of a ruling that would result in “millions of people losing their health insurance” and his admission that “there aren’t that many outcomes available” to mitigate that condition.
“If it doesn’t happen, he just says there’s going to be millions of people who lose those subsidies, lose their health care insurance,” Gupta observed. “There is no particular Plan B.”
While the president’s hands are probably tied if the Court pursues that course, it’s not clear that Obama would find that an unwelcome condition. Politically, the ACA has been and remains an albatross around his party’s collective neck, and Democrats are going to face significant headwinds in 2016 as a result of the public’s traditional resistance to handing the party in power a third term in the White House. Shifting the political burden associated with Obamacare from Democrats and onto Republicans in Congress, who would be subject to endless haranguing if they did not immediately restore subsidies to those who lost them in the wake of a Supreme Court ruling for the plaintiff, would serve Obama’s political purposes.
Republicans are aware of the bind they will be in if conservatives get a favorable ruling out of the Court, and they are reportedly preparing for the day after. But the prospect of GOP consensus on a plan to replace the gutted ACA seems fantastical.
“The chances that Republicans will actually agree amongst themselves on an Obamacare replacement are exceedingly slim,” The National Journal reported in March, “and even if they manage that and get something approved by both chambers of Congress – which may require the use of the special budget tool known as reconciliation – an awful lot of things would have to go right for their plan to work.”
This is the health care scheme that has come together piece by piece as the Obamacare foes in Congress have matured from tantrum-throwers to calculating strategists. The overall goal hasn’t changed—to get rid of Obama’s health care law. But the thinking about what to offer in its stead is only now starting to gel in the GOP caucus.
The nugget of the Republicans’ answer to the ACA was hatched eight years ago, well before Obamacare was conceived. Two veteran conservatives—Sens. Richard Burr of North Carolina and Tom Coburn of Oklahoma—believed it should be just as easy for an individual to buy health insurance as it is for a worker to sign up with an employer. The two lawmakers worked steadily on a proposal to use tax credits, cost-cutting tools like high-risk pool sharing, and health savings accounts to bring down premiums.
Burr recently described the proposal this way: “We’ve balanced the difference between employer-based coverage and individual-based coverage.”
The Burr-Coburn plan reportedly gained a powerful ally in Finance Committee Chairman Sen. Orrin Hatch (R-UT) this year, and House Energy Committee Chairman Rep. Fred Upton (R-MI) is also reportedly a booster of an amalgam approach that incorporates aspects of his plan in the House for an ACA replacement. But will this alternative be ready if the Court rules as many suspect it will? Surely, the president hopes it won’t be. And if it is not, Obama will have a new political cudgel to bludgeon the GOP with ahead of a difficult 2016 election cycle.