There’s been a spate of stories recently on how Republicans are fretting that they won’t be able to deal with the potential political fallout of crippling the Affordable Care Act. With a Supreme Court decision in King v. Burwell still pending and the fate of the ACA’s health insurance subsidies in the majority of states hanging in the balance, Republican politicians are in the awkward position of rooting for the subsidies to be killed but also seeking to avoid the blowback that would come from effectively kicking millions of people off their insurance.
This tension was perfectly expressed by Sen. Susan Collins when asked by the New York Times if she wants the high court to invalidate the ACA’s subsidies:
Asked if she hoped the court would rule for the plaintiffs, Senator Susan Collins, Republican of Maine, paused a moment, then said: “Yes, I guess I do. It would provide an opportunity to transition to a new law, or an improved version of the Affordable Care Act.” But she added, “I don’t think it would be fair to cut off people who have been using Obamacare subsidies.”
So Sen. Collins is pretty sure wants the court to cut off the subsidies, but she doesn’t think cutting off the subsidies would be fair. It’s the picture of clarity.
Collins, like many of her party colleagues, envisions a scenario in which Congress acts to temporarily reinstate the ACA’s subsidies while doing violence to other parts of the law, which, in theory, will buy the GOP time to craft its own replacement for the ACA in time for the 2016 elections. The problem with this approach is the same problem that’s plagued Republican healthcare policymaking efforts for years: irreconcilable internal divisions.
Hardline conservatives in Congress, represented by Ted Cruz, oppose any extension of subsidies and instead want to seize the opportunity King v. Burwell may provide to push for outright repeal of the ACA. As my colleague Jim Newell points out, they’re all working towards the same endpoint of completely blowing up the insurance market and returning to the awful pre-ACA days of insurance company discrimination and absurdly unaffordable coverage. They just can’t agree on how traumatic the regression should be.
Egging on these conservatives hardliners are outside groups like Heritage Action and Americans for Prosperity, which are lobbying Congress not to act to preserve the subsidies. “What we’re advising is to go with a completely different approach, saying we’re not going to refund or put back in place these subsidies,” Heritage Action told the Washington Post. “But what we will do is allow the states that are impacted by the decision to be able to opt out of all the mandates and all the insurance regulations that have driven up the price of insurance.”
What’s interesting about Heritage Action’s case is that they’re not saying a King ruling wouldn’t be disruptive; they’re arguing that it won’t be bad enough to justify what they view as the abandonment of the GOP’s political goal of repealing the ACA. But even by its rosy estimates, the impact of a King ruling against the ACA would still be pretty bad. A brief put out by the group earlier this month attempted to downplay the fallout, asserting that “only around 900,000 previously uninsured individuals have actually gained coverage as a result of subsidies,” and “only 5.5 million customers will lose subsidies.” You need to break a few million eggs to make a free-market healthcare omelet, I guess.
Internal fights like these hamper the GOP’s overall goal of tearing apart the Affordable Care Act while cynically pinning all the blame for the disruption that would cause on President Obama and the Democrats. As Greg Sargent pointed out, the general lack of public awareness about King v. Burwell gives the Republicans an opportunity to muddy the issue and capitalize on the confusion to promote their “tortured and incoherent” narrative on the case. But the GOP will be hard-pressed to claim Obama took away your Obamacare when they’re fighting each other over whether they should take away your Obamacare.