How many politicians, aides, lobbyists, lawyers, insurance moguls, professional groups and interns — both the political and medical kind — agonized over the details in the Affordable Care Act? The number is big.
But despite thousands of hands in the kitchen, the final product included four words that cast doubt on a cornerstone of the reforms — subsidies for those buying coverage on federal health insurance exchanges. Unbelievable.
Die-hard foes of the reforms have weaponized those words as a means to kill the law. They argue in the Supreme Court case King v. Burwell that specifically offering subsidies for plans bought on exchanges “established by the State” means no help for those going to federal exchanges.
Since the program started, low- and middle-income Americans have been receiving tax credits for coverage on both types of exchanges. Almost everyone assumes that’s how it’s supposed to be.
Take away subsidies for federal exchanges and only the sickly will join it. The economic structure underpinning guaranteed coverage will collapse as premiums charged for plans on federal exchanges soar and the healthy stay away in droves.
The plaintiffs, though they come from the right, are doing their Republican colleagues no favor. You see, when the Affordable Care Act created federal exchanges in states that had not set up their own, leaders in Republican-controlled states could noisily defy President Obama while taking few political risks. They could refuse to set up state exchanges knowing that their constituents would enjoy subsidized coverage on the federal exchanges.
Lose those subsidies and Republican politicians are going to have a lot of angry people on their hands. Some 7.5 million Americans receive subsidies on federal exchanges.
Hypocrisy now crashes over the Republicans’ wall of opposition to the Affordable Care Act. Politicians are currently rewriting the story of their obstruction of a law that they dread could come apart.
An exasperating example is Olympia Snowe, a former senator from Maine who fancies herself a moderate Republican. During the battle for the bill’s passage, she strung Obama along for months, pretending that she might provide him at least one Republican vote. (Why Obama indulged these stalling tactics … perhaps his memoirs will tell.)
Anyhow, Snowe recently commented that the little words at the heart of the Supreme Court case were unintended. “Why would we have wanted to deny people subsidies?” she said. “It was not their fault if their state did not set up an exchange.”
So why did she vote against the bill? She also railed against “Obamacare” as a “government-run health care system,” not that this was the case. Until Snowe left the Senate in 2013, she worked with her party to undercut the reforms.
But get this: At the time of the bill’s writing, Snowe proposed letting Americans buy cheaper drugs from Canada. It was OK, apparently, for a foreign government to help struggling Mainers obtain health care but not for their own.
One expects the health reforms to survive this latest assault. The best outcome would be the Supreme Court’s confirming that the words were a mistake and that yes, subsidies for the federal health exchange are legal.
If the court says no, politicians in states relying on federal exchanges could swing into action and set up some form of state exchange. And the Obama administration would probably make it easy for them.
The bipartisan takeaway here is the appalling state of American governance. We now hear from all sides that omission of subsidies for the federal exchanges was “sloppy,” “careless,” “inadvertent,” “a drafting error.” Actually, it was inexcusable.
But let’s move on.
Email Froma Harrop at fharrop@gmail.com.
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