Obamacare Reconciliation

The Supreme Court last week ensured that millions of Americans retained their health insurance. Those who kept their coverage sighed with relief. Democrats cheered.

Republicans reacted with vitriol and recrimination. Even the GOP dissenters on the Supreme Court couldn’t stop themselves from responding with bitter sarcasm. Weirdly too, with language like “jiggery-pokery.”

For the entire five years since Democrats passed the Affordable Care Act (ACA), Republicans have relentlessly attempted to kill it – along with some of its most vulnerable beneficiaries who’d lack life-saving health care if the GOP succeeded. Some Republican legislatures and governors have jubilantly exploited a provision in a previous Supreme Court decision to deny the working poor in their states access to the ACA’s expansion of Medicaid. But the GOP has lost the bulk of two appeals to the Supreme Court. And Republicans have failed at 67 attempts to repeal all or part of the ACA. They need to call off their war on health care now. Declare a ceasefire. Stop trying to slaughter a law that’s helping millions.

But if the colossal cadre of contenders for the GOP nomination for president is any indication, no armistice is in the offing. After the court announced the 6-3 decision Thursday, one Republican candidate after another railed against the majority on the Supreme Court and swore to take insurance from millions of Americans by repealing Obamacare.

Louisiana Gov. Bobby Jindal, whose announcement last week was overshadowed by the Obamacare and marriage equality decisions, tweeted, “President Obama and Hillary Clinton would like this to be the end of the debate on Obamacare, but it isn’t.”

Wisconsin Gov. Scott Walker tweeted: “Today’s #SCOTUScare ruling means Republicans must redouble their efforts to repeal and replace this destructive & costly law.”

New Jersey Gov. Chris Christie and U.S. Sen. Marco Rubio agreed, with Rubio telling CNN, “I remain committed to repealing this bad law.”

Former Florida Gov. Jeb Bush issued a statement saying that as president he would “work with Congress to repeal and replace this flawed law with conservative reforms.”

These responses are, as the GOP would say, bad and flawed. Republicans can deny it until the votes are counted in November 2016, but Obamacare works. Because of the ACA, a higher proportion of Americans are covered by health insurance now than at any time since the government began collecting statistics. More than 16.4 million Americans gained insurance under the ACA. Health care costs increases have declined to a record low. And untold millions of Americans value the law’s broad protections, including prohibitions against insurers denying coverage to people with preexisting conditions and against canceling coverage when policyholders become ill.

Now, it’s true that nearly all of these Obamacare-loathing Republicans, like Jeb, contended they’d replace it after repealing it. But that’s what the GOP has said all along. And they’ve got nothin’. There’s no plan. There’s no strategy. There’s not even an outline.

And there’s a reason for that. The conservative Heritage Foundation developed a plan, including the now GOP-hated individual mandate. Mitt Romney piloted that market-based program successfully when he was governor of Massachusetts. Then, the U.S. House and Senate embraced the framework of Romneycare and passed it. That’s the Affordable Care Act – created by conservatives, adopted by Democrats.

America’s got the GOP plan A. Republicans don’t have a plan B. If they did, they’d have produced it sometime over the past five years. They keep talking like they’ve got something, but it’s as ethereal as individual health insurance plans for people with preexisting conditions before Obamacare.

The GOP’s tactic of trying to destroy Obamacare in the courts has not served the party well. The first time around in the Supreme Court, the justices upheld the overall legality of Obamacare but did permit states to refuse the ACA’s Medicaid expansion. Despite that, a majority of states – 28 – as well as the District of Columbia covered their working poor by accepting the program.

Several Republican governors who opposed the expansion at first later reconsidered, mostly because infuriated hospital administrators pointed out that the refusal pushed their institutions toward bankruptcy as it forced them to continue providing uncompensated care to the uninsured.

Rebuffing the expansion costs states jobs and economic expansion as well. The Kansas Hospital Association estimated that the state’s rejection of Medicaid expansion in 2014 and 2015 set it back $714 million in federal funding and 3,400 jobs. Still, Kansas is a holdout. That snub to businesses doesn’t seem very Republican.

The federal government threatened Kansas, Tennessee, Florida and Texas with loss of Medicaid money that pays some of the cost of care for the uninsured if those states continue to refuse the expansion. For Florida, that’s $1.3 billion. That would be a big hit to the state’s economy and health care system. Still it’s a holdout.

That’s how much Republicans hate that Democrats passed their conservative health insurance plan.

This time when Republicans tried to kill Obamacare by challenging it in court, they got nothing. In fact, they got less than nothing. They ended up worse off.

The GOP wanted the court to outlaw subsidies that the ACA awards low-income people who buy their health insurance on the federal exchange. If the GOP had won, subsidies would have been denied to 6.4 million people who buy their insurance on the federal exchange because their states refused to establish their own insurance marketplaces.

But the majority on the Supreme Court declined to outlaw those subsidies. And it did so in a way that prevents a future Republican president from revoking the subsidies simply by changing an IRS rule. That’s a good thing for Americans receiving the subsidies.

But that doesn’t seem to be important to Republicans.

It should be. Here are two numbers those Obamacare-hating Republicans seeking the presidential nomination should keep in mind: While 1.8 million people who bought their insurance on the federal exchange live in counties that voted for President Obama, 4.5 million live in counties that voted for Romney.

Republicans may not want to be responsible for taking health insurance away from 4.5 million Republicans.

So they should stop trying. If they don’t like the Romneycare-inspired Affordable Care Act, they should try to fix it. Use some ingenuity to make it better. Arch-conservative Supreme Court Justice Antonin Scalia illustrated that Republicans are capable of that kind of creativity in his dissent filled with Shakespearean allusions.

The GOP would benefit from reckoning with this loss and abandoning its failed “repeal and replace” refrain. The American people who need health insurance would benefit if the party showed the slightest amount of Scalia’s inventiveness in GOP offers to work with Democrats to improve Obamacare.

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