Congress GOP considers stopgaps for health subsidies


by Melissa Nann Burke

Source: AZ Central

Congressional Republicans are considering extending Affordable Care Act health care subsidies temporarily, if the Supreme Court invalidates them later this month. But they also want to roll back other key elements of the law.

Details of the plans discussed in GOP House and Senate meetings last week remain in flux, in part, because the direction they take hangs largely on what the justices say.

On the House side, Energy and Commerce Committee Chairman Fred Upton, R-St. Joseph, has worked with two other committee chairmen on proposals to replace the health care law and respond to a ruling against the 5-year-old law.

The nation is watching the court Monday because it has 12 decisions remaining to be released. Among them are the health care case, Michigan’s fight against the Environmental Protection Agency’s pollution rules and a Hazel Park couple’s challenge of Michigan’s ban on gay marriage.

“It’s incumbent upon Republicans in particular, being the leaders of the Congress right now, to have a solution ready to go,” said Rep. Mike Bishop, R-Rochester.

“The question for Congress and, frankly, the American people, is: How do we get from here to 2016 when there’s going to be another president, perhaps more inclined to address the issue more as we’d like to address it?”

The tentative GOP plan would eliminate mandates for individual and employer-provided coverage and let states opt out of many of the law’s insurance rules, according to House staffers familiar with the talks. Senate Democrats are likely to oppose such measures, and President Barack Obama has said he won’t sign a bill that undermines his signature law.

U.S. Sen. Debbie Stabenow, D-Lansing, has said a Republican Senate bill to repeal the law but extend the financial assistance until 2017 is designed so the GOP may “win an election first and dismantle affordable health care coverage second.”

“Their real goal is to eliminate health care for 16 million people,” Stabenow said in an interview. “The problem is there is no real plan. It completely unravels health care.”

The Supreme Court is considering King v. Burwell, in which the plaintiffs argue that, based on the statute’s language, subsidies to lower monthly premiums should benefit only Obama health care plan enrollees in states that built their own insurance exchanges, and not to the 34 states, including Michigan, where the federal government operates the marketplaces.

The Obama administration maintains that Congress intended the subsidies, in the form of tax credits, to be available in all 50 states. The 4th U.S. Circuit Court of Appeals agreed, finding the subsidies “essential” to fulfilling the affordability goals of the law.

The justices’ decision could affect an estimated 7.3 million Americans in 34 states, including more than 228,000 in Michigan, who received tax credits when they bought their required health plans through the federal exchange in the past year. The average tax credit for Michigan consumers is $273 a month.

If the subsidies are ruled invalid, individual enrollees in the federal exchanges could face increases of 35 percent for average health premiums, according to Urban Institute projections.

Another 2.9 million enrollees would keep their subsidies regardless because they live in states that run their own exchanges and comply with the law.

Rather than frame the subsidy fix as a continuation of Obama’s health plan, Republicans say they must act to protect Americans from the administration’s illegal actions.

“We’ve already seen far too many families hurt by the president’s costly health care law, and we can do better,” said Rep. Tim Walberg, R-Tipton, who supports repealing the statute.

Rep. Sander Levin, D-Royal Oak, ranking member of the Ways and Means Committee, says Republicans are behaving as “armchair critics” while millions of people have coverage now who otherwise wouldn’t.

“What’s busted is not ACA but your attacks on it. Endless attacks. Never coming up with a single comprehensive alternative all these years,” Levin said at a hearing this month on Capitol Hill. “So, you’re livid because it’s getting better. That’s why you’re livid. I’m not surprised at your fervor. We’ll be glad to take it on.”

U.S. Health and Human Services Secretary Sylvia Burwell told the Ways and Means panel this month it’s up to Congress and the states to respond if the justices decide to void the subsidies. If Congress sends Obama a law that improves “affordability, quality and access, we are open to those things,” Burwell said.

Stabenow said she can speak firsthand about Congress’ intent as a member of the Senate Finance Committee panel who helped write the tax credit section of the law. She talked about getting the tax credit levels right so often during the markup process that then-Committee Chairman Max Baucus, R-Montana, dubbed her “Senator Affordability,” she said.

“It’s absurd that members of the Senate would vote to give some states tax credits and not others,” she said. “Of course, we meant for every state to have access to this, whether it was a state exchange or a federal one.”

Rep. Debbie Dingell, D-Dearborn, says the health care law is making it possible for more Americans to afford quality health care. “I fully expect the court to agree with legal experts across the spectrum that the ACA is being implemented properly and that subsidies through the federal exchange will continue,” Dingell said.

Bishop, who is enrolled in the plan like the rest of Congress, says his policy is pricey.

“I’ve got three kids, and our policy is a shadow of what it used to be. We have ridiculously high deductibles and co-pays,” said Bishop, a former state Senate majority leader who worked in the private sector until his 2014 election. “Sure, many people have policies now, but many can’t use the policies because of the high costs associated with them.”

Upton and some other GOP Michigan delegation members say they want to end the insurance mandates but retain other pieces of the health care law, such as letting children stay on a parent’s plan through age 26 and protecting coverage for people with pre-existing conditions.

Under the House GOP plan, according to staffers, states could opt for federal block grants to continue subsidizing people purchasing insurance. If a state chooses not to take the grants, the subsidies to that state’s federal enrollees would continue for a temporary period.

John Graham, a senior fellow with the conservative National Center for Policy Analysis, disagrees with the block grant idea because governors and legislatures might not agree on how to spend it. Congress should give the money directly to consumers to spend on care, Graham said, and eliminate the additional costs of channeling the money through insurers.

“The principle is that we don’t need every single penny of these billions going to the Blues and the Uniteds and Cignas and Anthems,” he said.

Short of a congressional solution, Gov. Rick Snyder has said he would ask the Republican-controlled Legislature to create a state-run health exchange if the justices toss out the subsidies. State lawmakers have refused to do so in the past.






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