Opinion

Obamacare after the Supreme Court ruling

This photo taken Oct. 3, 2014 shows the Supreme Court in Washington.
This photo taken Oct. 3, 2014 shows the Supreme Court in Washington. AP

The following editorial appeared in the Chicago Tribune on Sunday:

The U.S. Supreme Court is expected to rule within days on a key part of the Affordable Care Act, a ruling that could strip away federal subsidies that millions of people receive for their health insurance.

The issue: Whether the law provides subsidies only to people who signed up for insurance through an exchange established and run by a state. The problem is, 37 states rely on the federal health care exchange.

Many people would find their insurance is too expensive without the subsidy. For that matter, many people will find their insurance is too expensive in the coming months, subsidy or not, because rates are rising swiftly.

The court may well find a way to rule that the law permits the subsidies, but it’s not hard to see a majority going the other way and taking a strict interpretation of the ACA language. Then, absent a change in the law, the subsidies would vanish.

The Obama administration and Republican leaders of Congress have had months to prepare for that possibility. So what’s their backup? They don’t have one.

Health and Human Services Secretary Sylvia Burwell affirmed last week that the administration has no contingency plans set to roll out if the court rules against Obamacare. “The critical decisions will sit with Congress and states and governors,” she said at a congressional hearing.

Most states have done little or nothing to prepare. The states won’t be able to set up their own exchanges in time to avoid disruption. Illinois Gov. Bruce Rauner’s office says he will take “appropriate action” depending on how the court rules, but he won’t elaborate on what that will be.

So … Congress?

“Congress could fix this whole thing with a one-sentence provision,” President Barack Obama said in a recent speech to the Catholic Health Association.

Technically, yes, it could. But it won’t. Republicans have chanted “repeal and replace” for years.

The GOP leadership should, though, prepare to cushion the impact and buy time to pass a reimagining of Obamacare.

Republican Sen. Ron Johnson of Wisconsin has proposed to make a temporary fix and extend the subsidies through mid-2017, so people won’t abruptly lose health care coverage. That will also give Congress, governors and a new president time to plot a new course.

The law needs to change regardless of how the court rules. One alternative, the Patient CARE Act, has many elements that could attract bipartisan support. The proposal from Republican Sens. Richard Burr of North Carolina and Orrin Hatch of Utah and Rep. Fred Upton of Michigan would end the mandate that individuals buy coverage and that employers provide it. It would end taxes that shore up Obamacare spending. It would give consumers more flexibility and choice, allowing insurers to fit policies to consumers’ needs and their pocketbooks.

At the same time, two widely praised benefits would remain: Insurers wouldn’t deny coverage because of pre-existing conditions and young adults could be covered on their parents’ plan until age 26. Other Republicans and Democrats have ideas to free insurance markets and help more people buy affordable insurance.

The Supreme Court could soon jolt millions of people by ruling that Obamacare subsidies violate the law. If that’s how the ruling goes, let’s hope it jolts Washington to do something about it.

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