Republicans Thought They Could Put Off An Obamacare Replacement Debate TIl 2016

U.S. Sen. John Barrasso says Republicans thought they could put off a replacement debate for Obamacare until the 2016 election

GOP searches for elusive Obamacare fix

Republicans have been vowing to repeal Obamacare for nearly five years. But 2015 could be the year that Republicans finally define how they would replace it.

In March, the Supreme Court will hear another case that threatens subsidies that form a core of the Affordable Care Act. That has Republicans putting pressure on themselves to coalesce around a plan, drawing on ideas they’ve discussed for years such as tax credits to buy insurance, high risk pools and allowing insurance to be sold across state lines.King v. Burwell is the most serious legal challenge to Obamacare since the justices upheld the individual mandate in 2012. If King prevails, subsidies could be abruptly cut off to millions of people in states relying on the federal health exchange. That financial assistance would be available in just the 13 states running their own exchanges.

That would be a calamity for the health law, a blow to the insurance industry and a hardship for the people whose tax credits would be cut off.

The GOP wants to be ready.

“What the King case does is gives us an opportunity and a reason to come to a consensus sooner so, when we get the ruling of the Supreme Court in June, we are then prepared to say, ‘Here is what is better for the American people in terms of affordability, quality and choice,’” said Sen. John Barrasso (R-Wyo.), chairman of the Senate Republican Policy Committee.

Barrasso said Republicans earlier had thought that they could put off the replacement debate until the 2016 presidential campaign was well underway, and the GOP nominee put down a marker for the party.

The GOP conversations so far are preliminary, and a breakthrough isn’t imminent. Various Republican proposals have been put forth over the years, but forging agreement requires bridging deep ideological differences among Republicans about the scope of a plan, the role and responsibility of the federal government in health care, and how much to money to spend.

But Barrasso said several groups of lawmakers — members of the Republican Policy Committee and the two Senate committees with jurisdiction over health care — have begun talking about how to build consensus on a replacement plan.

The Republican moves come, ironically, as the Affordable Care Act is working fairly well. The three-month enrollment season for 2015 is going smoothly and will likely surpass the administration’s modest second year goals of having 9 million covered in exchange plans. As of mid December, more than 6 million had signed up in the federal exchange, a tally that will rise when the state numbers are added in. And there are two more months to go. Since the November midterm elections, three Republican-led states have proposed ways to potentially expand Medicaid under the health law. And the HealthCare.gov website is working.

But a ruling in King against the White House would hobble President Barack Obama’s signature law and spill over into the rest of the U.S. health insurance system. Without subsidies in two-thirds of the states, the uninsured rate would probably rise, reversing its sharp decline. Premiums could soar if only the sickest people stick with their more expensive coverage.

And the GOP could face a political backlash if people lose coverage from a lawsuit it supported — reminiscent of the fury Obama faced over last year’s plan cancellations.

That threat will dangle over the law until the court rules, likely in June. The uncertainty surrounding the court case also adds complexity to the Republican attempts to undermine the law through repeal votes as well as the budget process known as reconciliation. 
Republicans may wait until the court’s ruling to decide how they want to use reconciliation.

No matter what strategy they adopt, they won’t be able to get rid of the law legislatively while Obama is in the White House — although they hope that the Supreme Court could create an opening for significant changes.

“If [the justices] do what I think they should do — if they really read the law and act according to the way the law is written — then we’re going to have a real problem in America,” said Sen. Ron Johnson (R-Wis.), who is up for reelection in 2016 in a state that Obama carried twice. “The American public’s going to be asking us to act at that point in time. So we’ve got to figure that out.”

Republicans cite a sense that articulating their own alternatives may send a message to the Supreme Court that it doesn’t have to fear health care chaos if it rules against the White House.

To that end, GOP Sens. Richard Burr of North Carolina and Orrin Hatch of Utah are tweaking their Obamacare replacement draft, which is probably the most comprehensive in the Senate. They’ve brought into the discussion two other key committee chairmen — Fred Upton (R-Mich.) of the House Energy and Commerce Committee and Lamar Alexander (R-Tenn.), incoming chairman of the Senate Health, Education, Labor and Pensions Committee.

“The onus is on us to present a logical solution prior to that case ever being heard,” Burr said. “Maybe the court will feel more confident making a decision if in fact there is a legislation solution [to the subsidy problem] that is realistic.”

Several House Republicans have replacement plans as well. Dozens of conservatives have signed on to a Republican Study Committee replacement plan that has the backing of House Majority Whip Steve Scalise.

Whether a vote on a replacement plan actually takes place is far from certain. In the nearly five years since the law passed, there have been dozens of repeal votes — but not a single vote on a replacement plan in either the House or the Senate. And a “replacement” that unwinds most of the Affordable Care Act would never become law with Obama still in the White House.

Meanwhile, Democrats are preparing for yet another year of defending the five-year-old law.

They’ve consistently struggled to figure out how to message the law, a problem that’s likely to be more acute with near-constant attacks on the law in 2015.

Sen. Chris Murphy (D-Conn.) says Democrats are hoping to bring the people who are benefiting from the law into their argument next year.

“We’ve got to go out and build coalitions all across the country to defend the gains,” Murphy said. “We now have millions of people who have something to lose by repeal. We’ve got to do a better job of organizing those groups to come up to Congress and be actively opposing repeal.”