WASHINGTON—Congressional Republicans are nervously wrestling with how to respond if the U.S. Supreme Court in June strikes down Obamacare premium subsidies in up to 37 states.
There are at least five proposals from Senate and House Republicans, and they differ considerably. Most seem intended to delay or reduce the pain of millions of Americans losing coverage until after the 2016 elections. But it's highly uncertain whether Republicans can unite behind a single plan.
Sen. Ron Johnson (R-Wis.) introduced a bill, backed by Senate Majority Leader Mitch McConnell, to keep current subsidies in place through August 2017. His plan would prohibit new customers in the exchanges from receiving subsidies, repeal the individual and employer mandates, and eliminate the Affordable Care Act's essential benefits requirements.
A proposal by Sen. Ben Sasse (R-Neb.) would phase out subsidies over 18 months. During the transition period, insurers would be barred from raising premiums.
House Ways and Means Committee Chairman Paul Ryan (R-Wis.) proposed a flat tax credit to people receiving subsidies through the federal exchange, and let states opt into a more conservative reform model without insurance mandates.
The most conservative House Republicans are crafting a plan that would replace the ACA with an expansion of health savings accounts, medical malpractice caps and a provision allowing insurers to sell plans across state lines.
Dean Clancy, a conservative healthcare policy analyst, said that instead of tweaking the ACA because of panic over the potential elimination of subsidies, Republicans should offer a more comprehensive replacement bill, even if it's certain to be vetoed.
But Yevgeniy Feyman, a fellow at the conservative Manhattan Institute, said Republicans need to extend coverage subsidies if the high court kills them. “They definitely don't want to put red state governors into a corner where the only option they really have is to go to HHS and say, 'We're going to set up an exchange,' ” he said.
Tim Jost, a law professor at Washington & Lee University who supports the ACA, said the Johnson and Sasse bills would result in far fewer Americans being able to obtain affordable coverage, and would produce severe insurance market disruption.
The president, he predicted, would tell Congress to pass a simple legislative fix clarifying that subsidies are available in all states.
“The approach of the Obama administration has been, 'You broke it, you bought it,' ” Jost said.