In June the Supreme Court is going to rule on a case (King vs. Burwell) that has serious potential to greatly weaken Obamacare by using the language in the bill itself to declare some of the federal government subsidies illegal (specifically, in cases where the state has not set up its own exchange). If this happens, the people in those states will still be on the hook for insurance but it will be far more expensive--probably fatally so.
The merits of the case (or not) are out of scope for The Omnivore (he reads analysis as well as anyone else but is not a lawyer nor an expert in medical-care law)--but the ramifications of the event are clear: this is the probably the best shot Republicans have ever had--and if they do not win the presidency in 2016 while keeping the House and Senate, the best they will ever get, for repealing Obamacare.
The path, however, is fraught with danger. The GOP will have to thread a delicate needle to capitalize on the opportunity, move quickly to attain, keep, and deliver on significant voter faith, and act with some degree of bi-partisan support to enact changes.
This is the Olympic-Feat level of governance. If the GOP proves up to it, their various missteps may be forgiven. If they bungle it, symbolically it should be the end of the party*.
What Must The GOP Do?
The window of opportunity opens immediately when / if SCOTUS rules that the subsidies are illegal. At that point there will be a blizzard of options on the table and there will be a crisis: 13.4 million people, largely in red states will lose their subsidies and be in danger of losing insurance. Click the link for an interactive map. There will, immediately, be a simple option on the table: pass a bill to amend the existing law by about 4 words.
This will be a "familiar" showdown: The Senate Democrats--a minority party--declare, as bloc, they will filibuster anything but a clean bill to amend the law. Obama declares he will veto anything but a direct legislative fix. The heat level for millions of people means this is ALL OVER the news. At this point, the familiar fault-lines will appear. This is the nightmare scenario--and, if you are honest--a reasonably likely one:
- The ideological House can (may) declare they will only present the Senate with full-repeal bills or some other go-for-broke (full illegal immigrant deportation?) rider.
- Senate Republicans--especially in afflicted states--watch their positives fall since the media-messaging is very clear that this "could just be fixed."
- Major insurance carriers, who currently profit from Obamacare and are institutionally afraid of tectonic legislative change, add their voices to the fray. This helps create a sense of "impartiality" that many marginal observers will believe.
- The GOP proposes an alternative but--in this scenario--infighting between the Let-It-Burn caucus and the We've Got To Help Our People (GOP Senators) caucus leads to a broken-glass mess of fractured and contradictory messaging, amplified by the media (who don't just 'smell blood in the water' but are doused with it, Carrie-style) convinces people that the alternative may never launch.
- What should be a concerted attempt to both present a viable alternative and pin the blame for the failure on Obama and the Democrats (no GOP person voted for Obamacare and the language was written by Democrats) collapses in an avalanche of falling poll numbers.
- The Stand Firm caucus (led in the Senate by Ted Cruz) tries to hold on--but afflicted states, with help from Insurance Carriers (the WellPoint company stepped in to help with the failing O-Care roll-out), enact a "work-around" that uses a cheap, quickly created 'front-end' over the existing Federal Exchange, claiming they have solved the problem (several states already do this). Republican threats to bring THAT up with a lawsuit look petulant and the clock--the clock is running out.
- Eventually everyone collapses and passes a fix with further legal action pending. The base defects.
If you--presumably a GOP voter--think this couldn't happen? GIVE THE OMNIVORE YOUR DEALER'S NUMBER. Seriously: this is the recurring pattern we've seen before. On the other hand: things ARE different this time.
What's Different Now?
Two things are different here than have been true before in similar show-downs. These are:
- The mess is NOT bi-partisan. Wrangling over government funding and the debt ceiling targets the nation as a whole. In this case, no matter what Team Obama says, the problem was created by their own hand (assuming SCOTUS finds a problem in the first case, of course). In this case it's the Republicans arguing for the "status quo" for once.
- The Republicans actually do have a viable-looking alternative that, while it hasn't gotten homecoming queen-level fanfare, could, if carefully rolled out and shepherded make a case for changes.
What's That Plan?
Here's a pretty good look at it. A few key points:
- It doesn't subsidize the middle class as much as Obamacare but it does give an Earned Income Tax Credit to lower incomes (for them to go buy insurance wherever). It won't insure as many people as O-Care but it doesn't just cast the poor out on the streets either. It's meant to be cheaper and more sustainable.
- It keeps many of the popular protections of Obamacare (but see below) like the kids-on-insurance-until-26 provision.
- It ends the Medicaid expansion (but, again, tries to make it more affordable to buy insurance in general).
- It removes a lot of the policy-requirements (like free birth-control) from the insurances.
While some of these are marginal differences (no Medicaid expansion--but EICs--which mean you can get back more money than you paid in--meaning it's effectively the government sending money to the poor to buy insurance with) there are a few points you should be aware of:
- The lack of restrictions on plans mean "junk plans" might arise--plans that are sold to suckers that appear to cover things . . . but really don't.
- The proposal grandfathers you in--but then, if you do lapse, you get hit with the pre-existing condition. This has potential to be a killer: if you are dead-ass broke and unemployed, you probably can't keep coverage (maybe there is some kind of "carry me for 10-cents a month plan?" The Omnivore doesn't know)--but if that happens or if scenarios are realistically posited, they'll draw sympathy.
Still, this is a reasonable looking plan. It seems like it could draw bi-partisan support. Even more important: it can be sold as a serious GOP-driven reform that is in the best interests of millions of non-rich, demographically diverse Americans.
What's The Problem?
The end-state: the GOP getting to roll-back, replace, and (arguably) improve Obamacare without having to overcome electoral hurdles and done in a way that leaves their hands clean (it was SCOTUS and the Democrats that killed Obamacare!) seems like a goal everyone on the Red Team would be driving for. Alas, The Omnivore isn't overly optimistic.
Firstly, the plan does provide a fair amount of "free stuff"--there are going to be ideological partisans--and maybe a lot of them--who won't go for that.
Secondly, this proposal does NOT require the actual repeal of Obamacare. This reality alone, that a hybrid solution might move forward, could feel like a loss or betrayal to much of the base. Already some Republicans are suggesting that a major change should wait until 2017--that is: if SCOTUS strikes down the exchanges, pass a legislative fix that lets them continue business-as-usual until 2017 (when both bills can be "on the ballot"). This is the kind of thing that sounds like a dream-come-true to the base who may believe that with O-Care on the ballot they can't lose! This isn't the case: millions of people who like being covered will resent being used as a political football. If the GOP loses the ours-is-better messaging war, the battle's over.
How much would bet on the GOP's SEAL-Team-Level Elite Messaging Machine?
Yeah: me neither.
So the GOP has its work cut out for it. It needs to consolidate around a plan that hits the center of the electorate (very hard), make its case to the electorate (hard), contain the no-compromises caucus (maybe impossible), and then move as one when the opportunity presents itself to act in a bi-partisan fashion and convince Obama that, in good faith, this is best for the country (unicorn-level).
* To be clear about that: bungling the chance to repeal or reform O-Care will not necessarily be the end of the party--The Omnivore isn't saying that. However, this event is pretty much core to the Tea Party's reason for existence. It represents the GOP's current ideological engine. If the Republicans can't manage to come together on this--with some degree intra and inter-party compromise and all that entails (meaning: governing a nation that is polarized and in danger of fraying) then, simply put, The Omnivore doesn't see how you make a case that it isn't time to give someone else--some other party--a chance.