The Affordable Care Act is before the Supreme Court again.
The reason is that a particular part of the law was written in an ambiguous way. An opponent to the ACA found this ambiguity about a year after the healthcare law actually rolled out, or almost four years after the law was actually published.
This ambiguity involved federal subsidies promised to those who purchase through through the state exchanges. The law also allows states the option of setting up their own exchange or using healthcare.gov. This particular set of language, however, says that federal subsidies for those who can’t afford to pay the full cost of healthcare coverage will flow to those who purchased their insurance through a state exchange. It makes no mention of subsidizing those who purchased their insurance through the federal exchange. When the law was written, the expectation of the authors was that every state would set up their own exchange. Most republican states, however, opted for the federal government to run their exchange.
The result is a law suit suggesting that those who are implementing the law have overstepped the provisions of the law by providing federal insurance subsidies to everyone who qualifies even if they purchased their insurance through the federal website.
This raises the real possibility that if the Supreme Court upholds the literal interpretation of this law, millions of people will lose the government subsidies they require to be able to afford purchasing insurance.
So what happens to them?
Fortunately the Republicans in the person of Paul Ryan, have offered to come to their rescue.
House Republicans have formed a working group to propose a way out for the affected states if the court rules against the administration.
This statement is particularly interesting because it is not the first time that Republicans in general, and Paul Ryan in particular have promised to develop something to replace Obamacare. So far, however, they have only formally proposed one alternative in 2009. When that was scored by the CBO, it cost $30B more than Obamacare and covered less than 10% of the population covered by Obamacare. In the five years since, the House has voted to repeal Obamacare 67 times without any serious alternative.
That didn’t stop Paul Ryan and the Republican party from claiming that they were working on an alternative in part to reassure those who were concerned that they would be left with nothing if the Republicans were successful. Here’s what he said January 20, 2011 in the lead up to the 2012 campaign.
We will hold hearings in Washington and around the country. We will invite affected individuals and job creators to share their stories and solutions. We will look to the Constitution and common sense to guide legislation.
Replacing this law is a policy and a moral imperative. We reject the premise that the only way to improve access to quality coverage is to dramatically expand the federal government’s reach into our lives. On the contrary, we are dedicated to solving the underlying problems in health care by prioritizing affordability, improving transparency, and creating a true, functioning marketplace for health insurance.
No hearings were ever held.
Ryan then spent a year campaigning on the subject with Mitt Romney promising to “repeal and replace Obamacare.”
They talked a lot about the repeal. They never provided any details on the “replace”.
In the meantime, Philip Klein of the right wing Washington Examiner rag has made a career out of proposing alternatives to Obamacare. He wrote an entire book on the subject that was published earlier this year.
Why haven’t they provided their own alternative? Because there isn’t another alternative that is cheaper and free of the same political tradeoffs that are present in Obamacare. Any plan that Republicans might choose to present will either cover fewer people, cost the government more money, and/or cost policy holders more money.
Republicans decided five years ago that they did not have to engage in a debate about the best healthcare policy for this country. They only had to regularly lie about how terrible it is and that a vote for them was a vote for Obamacare repeal.
While that, and gerrymandering, may be sufficient to keep House Republicans in power, it will not be enough to win them the White House, and may not be enough for them to keep their slim majority in the Senate.
But House Republicans don’t seem to care about much about governing anyway, so it is unlikely that we will see much change in this particular deception.
Over the next several months we’re likely to see some additional promises from Republicans with an eye on 2016. We’ll review each of those proposals as they are presented to see how they measure up. Ted Cruz’s Teddycare is the first in that series.