WASHINGTON — Congressional Republicans have long been on an elusive hunt for a plan to replace the Affordable Care Act, but a group of them, including Rep. John Kline, think they’ve come up with the solution.
Leadership tapped Kline as one of three committee chairman to write a replacement plan earlier this year. Though past efforts have failed, Kline and his compatriots used Wednesday’s Supreme Court hearing on the ACA’s insurance subsidies to preview what they hope will make the cut this year.
A ruling against the law’s subsidies could end government support for up to 8 million people who got health coverage through federal exchanges, potentially forcing them off out of the market entirely, driving up costs for everyone else and threatening the very nature of the law. (Minnesota established its own exchange, so beneficiaries here aren’t directly at risk.)
Republicans are using that possibility to make their pitch: give the states the opportunity to bypass the law’s coverage mandates and allow them to set up their own insurance frameworks; maintain a handful of politically popular Obamacare coverage requirements; and create a tax credit for individuals who need help buying health coverage.
Politically, it’s exceedingly unlikely the three big factions of lawmakers — Republicans and Democrats on Capitol Hill and President Obama — could ever agree on a replacement plan even if the subsidies fail at the Supreme Court. And details are still in short supply on what exactly Kline and the Republicans will include in their bill. But this is nonetheless the foundation on which they are working to build their plan.
“Right now, people are pretty dug in,” Kline said Wednesday. “The Democrats are pretty firmly supporting Obamacare, and that’s what you’d expect. But the point is, if King v. Burwell (the case before the Supreme Court questioning the exchanges) comes down the other way, then from their perspective, then you really do have something that has to be addressed. We want to make sure that we’re ready to do that, as well as a long-term replacement.”
Details scarce right now
With health insurance subsidies potentially on the chopping block at the Court, Kline’s plan, written with fellow chairmen Reps. Fred Upton and Paul Ryan, would look to replace them by instead offering tax credits to those who need them to buy insurance.
The credits would be available either immediately when someone needs them to buy insurance or refundable at tax time, Kline wrote in a Tuesday op-ed in the Wall Street Journal about the plan. But that’s about all we know — Kline didn’t have details Wednesday on how big the subsidies would be, or who would qualify for them. That will come later, Kline said, and probably from Ryan, who chairs the tax-writing Ways and Means Committee.
Specifics were scarce on Wednesday. The op-ed was meant mainly to introduce the ideas that will guide any GOP health care legislation this session. But since a bill hasn’t been formalized, it’s hard to compare what Kline and Republicans want to do with what’s in the law already.
Much of the proposal is made up of policies long supported by Republicans. Ideas they say would bring down the cost of health care — such as allowing insurance purchases across state lines and reforming medical liability — are hallmarks of GOP health care reform plans, none of which have gained traction with Democrats.
Since the ACA became law, Republicans have railed against Obamacare mandates like the individual coverage requirement and the forcing of employers to offer health insurance to workers. Democrats have rejected efforts to repeal them. The Republicans’ replacement bill would give states the chance to opt out of those mandates and build insurance requirements of their own.
And though they plan to preserve politically popular aspects of the ACA — a pre-existing conditions ban, allowing those under 26 years old to stay on their parents’ plans — Kline couldn’t say how they would fit those into the context of a replacement bill meant to cut back on federal health care mandates.
“We’re basically not mandate people, so we’re working not to do mandates wherever we can,” he said. “But again, I can’t tell you what the language is going to be here. All I can tell you is we are actively working on it all the time.”
First replacement bill faces tough test
Republicans have never taken up a full replacement bill before. Though they have tried — with some, but little, success — to repeal or replace sections of the ACA more than 50 times since they took control of the House in 2011, Kline said a Supreme Court ruling against the ACA in the King v. Burwell case could provide the impetus to pass a full replacement bill this session.
“The action of the Supreme Court is going to force something, and it’s helpful that that’s going to happen,” Kline said. “Republicans have been talking about an alternative, we’ve been criticized about voting again and again to repeal Obamacare. … We are looking to courts and we understand the courts will make their decision whenever they make it, and we probably won’t hear the court’s decision until June.”
Passing a bill will be difficult. Republicans are unlikely to find willing partners in Democrats, who continue to support the ACA and who haven’t proposed any potential fixes to the law should the court gut the subsidy program. President Obama told Reuters this week, “if they rule against us, we’ll have to take a look at what our options are, but I’m not going to anticipate that.”
Democrats have mostly been making the case that the court shouldn’t rule against the subsidies because it would threaten the effectiveness of the entire law.
“This thing completely unravels,” Minnesota Sen. Al Franken said at a press conference after oral arguments Wednesday. “That’s what at stake, and the Supreme Court is supposed to take that into account.”
Oral arguments in King v. Burwell began yesterday and Justices Kennedy and Roberts seem to be in play as to which side they will join.
Republicans will need to coalesce around a single plan if they’re to pass something, since other Republican groups are working on their own ACA plans, as well. The conservative Republican Study Committee, in on op-ed of its own, has proposed a different health care-related tax plan, effectively a tax cut “for the majority of Americans” that could go toward health insurance.
Ryan has worked to distance his and Kline’s tax credit proposal from the subsidies in existing law, saying Tuesday that the ACA’s subsidies are there to force people into Obamacare, while Republicans would provide tax relief to let people buy plans outside of it. Kline said “I certainly hope” to get buy-in from conservatives for his proposal.
Ron Pollack, the executive director of the pro-ACA group Families USA, who was helping lead demonstrations outside the court Wednesday morning, said he doesn’t expect any sort of legislative response from Congress if the court undoes the subsidies.
“This is obviously an attempt to tell the court, well, don’t worry if you rule in a way that takes away the subsidies,” he said. “But if it ever gets to Congress and they have to fix it, it won’t get fixed.”
Devin Henry can be reached at email@example.com. Follow him on Twitter: @dhenry