June 10--Great news, everybody. After years of trying to conjure an Obamacare alternative through the art of rhythmic complaining, Republican lawmakers have finally come up with an idea.
More on that in a minute. First, let me detail why this is such an important development.
The U.S. Supreme Court is expected to rule this month in a case called King v. Burwell, and that ruling could cause more than 6 million people to lose the government subsidies that help them afford health insurance under Obamacare.
The case focuses on one line in the Affordable Care Act that says subsidies -- financial assistance from the government that helps many afford health insurance -- will go to people enrolled "through an Exchange established by the State."
The law was set up with the expectation that states would create their own health insurance exchanges. If a state declined to do that, the government would step in and offer insurance through a federal exchange.
Though the key intent of the law is to give everyone access to affordable health care, the plaintiffs in this case, recruited and funded by libertarian and conservative groups, claim that one sentence means subsidies should only go to people in states that have set up their own exchange. In other words, Obamacare enrollees in dozens of states that use the federal exchange shouldn't be getting subsidies.
It's a preposterous argument based on sloppy language in one small part of a massive law. If the intent was to set up a federal exchange but not give people subsidies to help pay for insurance, the Affordable Care Act would effectively be shooting itself in the foot.
But language matters, and it's now up to the court to decide whether to look at that sentence in the broader context of the law -- in which case it's obvious subsidies are available to people on state or federal exchanges -- or to hone in specifically on that sentence and pull subsidies from millions of people, including more than 200,000 in Illinois.
One possibility is that the justices will strike down Obamacare subsidies in the 37 states that didn't establish their own insurance exchanges and then rely on Congress to step in and help those people out.
During oral arguments in the case, Justice Antonin Scalia said: "What about Congress? You really think Congress is just going to sit there while all of these disastrous consequences ensue?"
The problem with that thinking is that it's insane to count on Congress to do anything. It's like a man with diabetes taping his credit card to a snail, pointing it in the direction of the pharmacy and asking it to go pick up his insulin.
The whole issue at hand in King v. Burwell could be fixed by tweaking that one sentence, but Republicans are more likely to get "I Love Hillary" tattooed on their foreheads than do anything to help Obamacare.
So, if the Supreme Court guts Obamacare, what will the GOP do? Simple. They'll do what they've been promising ever since hating Obamacare became their favorite pastime: Offer an alternative to the health care law that will help all Americans and satisfy the conservative base.
That alternative was outlined in a recent tweet sent by Republican Sen. John Thune of South Dakota: "Six million people risk losing their health care subsidies, yet @POTUS continues to deny that Obamacare is bad for the American people."
That's it, folks. That's the plan. Blame Barack Obama.
Let me break down Thune's tweet:
-- Six million people losing health care subsidies is a bad thing.
-- Those people received subsidies because of Obamacare, which is a bad thing.
-- They may now lose subsidies because of a lawsuit pushed by Republicans dead-set on destroying Obamacare. That's a good thing.
-- If Obama had never helped them get insurance in the first place, those 6 million people wouldn't be in danger of losing insurance.
-- It's all Obama's fault.
It's perfectly logical, assuming that the part of the brain responsible for logical thought has died off due to lack of use.
Under this new GOP health care system, people who have insurance through their employers or who can afford to pay for Obamacare insurance without subsidies will still operate under the same kinds of plans, like HMOs or PPOs.
Those who needed subsidies to afford insurance through Obamacare, however, will be moved to plans called BBOs -- Blame Barack Obama.
The great news is that if you like your doctor, you can keep your doctor. You just won't be able to see that doctor because he or she will not accept BBO plans, because they don't pay anything.
The BBOs will focus on a more natural form of healing predicated on the belief that not having to live under the tyranny of Obamacare will heal all that ails you. For example, if you break your arm and can't afford to see a doctor, the BBO plan will reassure you that pain builds character and that it's better to have the use of only one arm than to have government coming between you and the doctor you can no longer afford.
Feel a mild case of Ebola coming on? Blame Barack Obama!
Sprained an ankle? Blame the pain away!
Need a heart valve replacement? Say farewell to your loved ones and remind them to blame Barack Obama!
The GOP's BBO Obamacare Replacement Plan will cost far less than the Affordable Care Act, because instead of cynically helping millions of uninsured people gain health insurance, it does nothing.
And nothing is exactly what the Republicans had planned all along.
rhuppke@tribpub.com
