Republicans in the House and Senate insist they have a plans to handle the fallout from a ruling against the Affordable Care Act in King v. Burwell. They’re terrific plans, we’re told, and they’ll do a great job of patching up the damage that the Supreme Court could inflict if it decides that the ACA’s health insurance subsidies are illegal in 34 states. Unfortunately, none of us are allowed to see the plans because they’re super-secret.
Secrecy notwithstanding, the consensus seems to be that the GOP’s most likely path forward will be something along the lines of what Sen. Ron Johnson has proposed: agree to extend the ACA’s subsidies for a limited window in exchange for killing off other parts of Obamacare that actually make the law work. Other Republican proposals that are floating around also endorse temporarily extending the subsidies in some form, indicating that some Republicans understand that there would be a terrible human (and political) cost to this outcome that they’re so enthusiastically cheering for – people losing their insurance, losing access to healthcare, and dying preventable deaths. They recognize the need to act, but if we’ve learned one thing about the GOP and healthcare policy over the years, it’s that they can’t agree on anything beyond “Obamacare is bad.”
The feral dislike of the Affordable Care Act that the Republicans have happily cultivated over the years is coming back to bite them now that they could actually find themselves in a position of having to legislate on healthcare policy. To see how, one need look no further than Sen. Ted Cruz. Speaking to Politico, Cruz categorically ruled out supporting any legislation that revives the Affordable Care Act’s subsidies, even temporarily, should the court knock them down. His rationale is simple: The Republicans will finally have Obamacare on the ropes, and they should use that opportunity to go in for the kill.
“I think the best legislative option is to allow states to opt out,” Cruz said in the Capitol. “I am cautiously optimistic that the Supreme Court will conclude in King vs. Burwell that the Obama IRS disregarded the plain language of the statute and acted lawlessly. And when that occurs, it will be a real opportunity for Congress to lead.”
He added: “In a perfect world, we would take that opportunity to repeal Obamacare. At a minimum, we should allow states to opt out.”
Cruz is very much an opponent of Obamacare, and he very much disagrees with the notion that government should be subsidizing health insurance premiums. When a lower court ruled against the ACA in a case similar to King, Cruz celebrated the decision, saying it “should shield citizens from Obamacare's insidious penalties, mandates, and subsidies.” Earlier this year he introduced legislation that would repeal huge parts of Obamacare and replace it with free-market fairy dust. To Cruz’s reckoning, extending Obamacare’s subsidies – even if the extension is temporary – is akin to endorsing Obamacare’s policy goals, and he won’t have any of it.
Cruz is certainly not alone among Republicans in Congress in his “let it burn” approach to King. You can bet that if the Supreme Court cripples the ACA by taking away the subsidies, more than a few conservative and Tea Party legislators are going to balk at the idea of “bailing out” or “fixing” Obamacare by restoring the payments.
And that is obviously frustrating to the Republicans who are pushing the Johnson plan and others like it, since none of them are particularly gentle to the Affordable Care Act. As Jonathan Cohn points out, Johnson’s plan would repeal critical parts of Obamacare in states that wouldn’t even be affected by the King ruling. The other Republican plans would inflict similar violence upon the law as the price for temporarily extending the subsidies. All of the GOP plans would cause premium spikes and shrink the individual market for health insurance precisely because they call for the weakening and eventual demise of the protections and regulations put in place by the ACA.
But Cruz and his allies are so rabidly anti-Obamacare that even that isn’t good enough. They want as much damage as can be done to the law and they want it done immediately. That’s a problem for Republicans like Mitch McConnell, John Barrasso, and Ron Johnson, who would much prefer to argue that Republicans are trying to “protect” people as they move to dismantle the Affordable Care Act piece by piece. And so, amazing as it may seem, the Republicans can’t even agree on the one healthcare policy item they ostensibly agree on. They all want to see the Affordable Care Act gone, but they’re divided on how painful the process should be.