Millions of Americans, including many right here in the state of Florida, could soon lose health insurance when the Supreme Court decides the latest challenge to the Affordable Care Act (Obamacare) this month, but states have made few concrete plans to deal with the potential fallout, and they may get little help from Washington.
A new Washington Post/ABC News poll found that a majority of the public, 55 percent, does not want the court to block federal subsidies for people in states that have not set up their own exchanges. They also are in favor of keeping the preexisting condition clause in the law. Only 38 percent said they wanted the subsidies ended.
“It does create a political problem for the GOP because there could be millions of people who got health insurance as a result of ObamaCare who lose it,” said Darrell West, director of governance studies at the Brookings Institution.
When the court rules this month, the justices may eliminate insurance subsidies in as many as 37 states that use the federal HealthCare.gov marketplace established through the health law. The law’s challengers argue that a strict reading of the statute makes those subsidies available only in states that established their own marketplaces, rather than having the federal government operate the marketplace for them.
A state could restore the aid if it runs its own marketplace, as California and 12 other states and the District of Columbia already do. Just two states whose residents are in jeopardy — Pennsylvania and Delaware — have outlined strategies for preserving subsidies, however.
This poses a conundrum for Senate Majority Leader Mitch McConnell (R-Ky.) and Speaker John Boehner (R-Ohio). They are under pressure from colleagues up for reelection in swing states and districts to extend the subsidies, at least temporarily, if the court strikes them down. But doing so would risk a backlash from the conservative base.
Democrats feel confident that Republicans will be on the losing end if the court strikes down the subsidies. While congressional Republicans have publicly discussed five plans to respond to the ruling, President Obama and Democrats have not unveiled anything because they feel the law can be fixed by one simple change of a sentence.
President Obama said Monday at a news conference ahead of a Group of Seven summit in Germany that Congress could avoid any disruption in the subsidies by passing a “one-sentence provision” clarifying the federal government’s authority to set up exchanges.
Senate Republican Policy Committee Chairman John Barrasso (Wyo.), Finance Committee Chairman Orrin Hatch (R-Utah) and Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) are leading a working group that has met since January to explore legislative options.
In a March op-ed published in The Washington Post, Barrasso, Hatch and Alexander called for providing financial assistance to help Americans keep their coverage for a “transitional period” and giving states more flexibility to create more competitive health insurance markets.
But so far McConnell has made no effort to rally the conference behind one plan.
According to The Hill Sen. Ron Johnson (R), who faces a tough reelection in the swing state of Wisconsin, has proposed legislation to extend subsidies until August 2017 and repeal the Affordable Care Act’s requirements to buy and provide insurance. Thirty-one Republican senators have co-sponsored the measure, including McConnell.
“My bill is a transition piece of legislation that will allow the American people a voice in what our health care system will look like beyond the 2016 election,” Johnson said in a statement. “It acknowledges political realities by preventing turmoil and disruptions should the Supreme Court rule subsidies cannot be paid through federal exchanges.”
Sen. Ben Sasse (R-Neb.) has floated legislation that would restructure the law’s subsidies and wind them down over the course of a year and a half.
If McConnell and Boehner opt to pursue these options, or something similar, it will provoke a fight with the party’s conservative base, a dangerous prospect heading into an election year.
“Our basic approach to this is, first of all, Congress shouldn’t overreact. You see some overreaction out there; the Johnson bill is a good example of that,” said Dan Holler, the communications director at Heritage Action for America.
“We think it’s a really dangerous step if you’re basically refunding ObamaCare. It’s not something the Republican conference should be doing,” he added. “Anything that gets at a straight extension of the subsidies is a nonstarter with conservatives.”
Senate Republican sources say McConnell would prefer not to deal with the political mess if he doesn’t have to.
*Some content used in this story came from the Associated Press and The Hill.
