Froma Harrop: The dilemma: Angry at Obamacare, angrier without it

Froma Harrop

Froma Harrop

Obamacare supporters are praying that the Supreme Court won’t chop down a main pillar of the Affordable Care Act — but not so fervently, one suspects, as the politicians who’ve been demanding the law’s demise. That’s because come the next election, Republicans will have to face the voters they’ve made angry over Obamacare — but who will be angrier should they lose it.

The justices are considering whether subsidies for people buying insurance through the federal health exchanges are legal. Without them, the exchanges would collapse as only sick people continue to buy insurance, causing premiums to skyrocket. About 8 million Americans — 6 million of whom are getting subsidies — would lose their coverage.

The added concern for Republicans is that these 8 million are concentrated in conservative states that refused to set up state exchanges, for which the subsidies are not in question. These are their voters.

Republican leaders have come up with replacements should the federal exchanges go down. Sadly, they are riddled with flaws hidden in vague language.

The rhetoric remains muscular, however. Rep. Tom Price, R-Ga., says his party has better solutions than to “force people to buy insurance they don’t need or don’t want.”

Problem is, many people don’t want insurance until they need it. Then it’s too late.

The Obamacare mandates require everyone to obtain a minimum standard of coverage. Every serious conservative plan for health reform has included a mandate forcing people to obtain coverage. The healthy subsidize the sickly. That’s how insurance works. What those who do the subsidizing get in return is the security of knowing that they, too, are covered when things go bad.

Three Republican senators, John Barrasso of Wyoming, Lamar Alexander of Tennessee and Orrin Hatch of Utah, propose offering temporary subsidies to those who lose their Obamacare subsidies. Guys, care to divulge what those subsidies would be and whether they’d be anywhere near what Obamacare offers? Or do you imagine that the need for subsidies will go away when good, affordable coverage becomes magically available?

Republican Sen. Ben Sasse of Nebraska suggests a temporary COBRA-like plan where people could keep insurance bought under Obamacare for another 18 months. Temporary solutions have been a hallmark of modern Republican governing. They give cover to conservative ideology while shielding the public from the consequences of it.

In the House, Republican Reps. Paul Ryan of Wisconsin, Fred Upton of Michigan and John Kline of Minnesota propose letting states do away with the mandates — as well as Obamacare’s minimum standards for coverage. So it’s back to plans that can offer very little coverage — and very unpleasant surprises for the policyholders who suddenly need expensive medical attention.

Tough luck. They should have bought the coverage they didn’t think they needed.

The Ryan-Upton-Kline plan would also offer tax credits to buy private plans and make them refundable for low-income folk who don’t pay income taxes. Subsidies again, by a different name. Meanwhile, the public would be vulnerable again to insurance company trickery.

Back in the Senate, Hatch and Sen. Richard Burr, R-N.C., have a plan that would offer tax subsidies to families earning up to 300 percent of the poverty level. Subsidies yet again. And what about Americans making more than that but whose families include sick people whom no private insurer would touch?

If the court rules against the federal exchange subsidies, Republicans will find themselves in a fine political mess. And Americans will be back in the dungeon of stress and anxiety over their ability to obtain health care. Or perhaps the justices come to everyone’s rescue and keep the subsidies. Let us pray, all of us.


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