Beep Beep

The Chase.  The endless effort to reach that which is just beyond our grasp has piqued our imagination since we, as small children, watched the Coyote try to capture the Roadrunner.  We knew, instinctively, that the Coyote would never succeed.  But what if he did?  What if the Coyote actually had his arms wrapped around the Roadrunner?  Would he know what to do?

The Coyote’s struggles are humorous entertainment.  The Republican’s efforts to eliminate or destroy the Patient Protection and Affordable Care Act (PPACA) have been just as entertaining if your tastes run towards political drama.  John Boehner and the Republican controlled House of Representatives have been chasing the PPACA for nearly four and a half years.  What would Boehner do if he actually got his hands on the PPACA, if the law was crippled or repealed?  We may soon find out.

This blog has long contended that the PPACA is a poorly written law in desperate need of tweaking.  Today’s problem revolves around the issue of subsidies.  The law was designed, in part, to help the working poor to acquire and PAY for quality health insurance.  The law’s framers envisioned individuals and families accessing a system of simple, online, state-based marketplaces and, when appropriate, tax credit subsidies to help with the premiums.  The process wasn’t all that easy and over two thirds of the states decided not to build an exchange.

Creating a state-based exchange requires an incredible amount of time and energy.  Some states see this as a huge waste of resources.  Others, like Oklahoma, have no interest in participating in the PPACA.  The federal government created the much beloved healthcare.gov so that the millions of residents in states like Ohio could purchase coverage and qualify for the tax credit subsidies.

This past Tuesday the U.S. Court of Appeals for the District of Columbia ruled (2-1) that people purchasing coverage through the federal exchange are not eligible for the subsidies.  Sure, a couple of hours later the 4^th U.S. Circuit of Appeals in Richmond, Virginia reached the opposite conclusion (3-0) on a similar case, but the door had been flung open.  One side or the other can still appeal, but the conflicting decisions, alone, may be enough to get this matter before the Roberts’ Supreme Court.

Could the Supreme Court eliminate the tax credit subsidies, the only way millions of Americans can afford to pay for health insurance?  Yes, they could.  Would the Supreme Court gut the PPACA?  Who knows?  Based on the Court’s recent decisions, any outcome is possible.

If the Supreme Court takes this case, I suspect that it won’t be until the fall of 2015.  That means that a decision would be handed down in June 2016, right in the middle of a Presidential election.  So let’s explore what would happen if the Supreme Court ruled that tax credit subsidies were only available on policies purchased on state-based exchanges.

• The immediate effect would be the elimination of assistance to approximately 5 million Americans.
• The Employer Mandate, a rule predicated on the availability of affordable (subsidized) coverage, would be shelved.

Republicans, having finally caught the PPACA, would be forced to actually do something.

There would be nowhere to hide.  Both parties would have to state clearly how they would solve this problem.  The quickest way to solve this specific issue would be to amend the law and allow subsidies for policies purchase on either the state or federal exchange.   Another option would be for the states could form their own exchanges or contract with a third party to piggy back on the federal exchange.  OR, we could just let everyone fend for themselves as we review the long-awaited Republican alternative.

The Republicans lose under all these scenarios.

If they fix this and a half dozen other major flaws in the law after six years of demonization, they will appear to be weak and hypocritical to their base.  The few Republican members of the House and Senate needed to pass the legislation will be pilloried on FOX and by the right-wing opinion makers.  It was Eric Cantor who originally introduced the “Repealing the Job Killing Health Care Law Act” HB 2 in January 2011.  He will be long gone before the summer of 2016, but Paul Ryan and Ted Cruz will still be in Congress and neither could let a fix get through Congress if they still have Presidential aspirations.

The state governors face a similar problem.  Republicans pushed through constitutional amendments in Ohio and other states that make the creation of a state-based exchange difficult if not impossible.  Many of the Republican governors are defined by their anti-Obama/Obamacare position.  They can’t bend.

The average tax credit subsidy is $5,000 per year, over $400 per month.  I’m not sure which would be worse, the actual suffering caused by the repeal of the subsidies or the inevitable hair on fire commercials about the suffering.  Hell, I’m suffering just thinking about it.

The Patient Protection and Affordable Care Act is almost within John Boehner’s grasp.  The House has voted to repeal or change the PPACA over 50 times.  But it may be the framers’ own mistakes, punished by a highly politicized Supreme Court, that will be the law’s undoing.  A victory he doesn’t want over a law he loves to hate.  Poor Mr. Boehner.  No matter where he goes the only sound he hears is “Beep Beep”.