Republicans in Congress talk about what to do if Supreme Court upends Obamacare

The last time the Supreme Court took up so called Obamacare, it surprised court watchers by ruling the individual health insurance mandate is constitutional under Congress’ power to tax, while also deciding Congress can’t compel states to expand Medicaid.

That has even the health law’s opponents now worried about the court reviewing the constitutionality of giving tax credits to millions of middle class Americans so they can afford insurance. 

It isn’t sitting well with Rep. Mike Fitzpatrick (R-Bucks County).

“Not a bill that I would have supported but a subsidy written into the act pretty clearly doesn’t apply to Pennsylvania,” he said. “And so there’s a core question that needs to be resolved but in the meantime I am concerned the constituents would lose what some have seen an affordable coverage for themselves by the way others have seen coverage go up.”

Democrats say the whole case against the subsidies is baseless because it basically hinges on four words: “established by the State.” As in, the federal government can only give subsidies to people in states that set up their own health insurance exchanges. Pennsylvania and New Jersey opted against that and rely on the federal exchange. Delaware and the feds run an exchange as partners. Fitzpatrick says if the Supreme Court rules in his party’s favor, pressure will be on the White House.

“I think it’s incumbent first on the president comes up with a solution, come to the House, who should be willing to listen how this is going to be resolved because constituents like mine and southeastern Pennsylvania who have relied on the provisions of Affordable Care Act would be at risk,” said Fitzpatrick.

But Republicans now control both chambers of Congress. Freshman Rep. Tom MacArthur from New Jersey (R-Ocean County) says his party will have to clean up any broken pieces if the health law starts to collapse.

“Look, first we need to have the rule of law and I think Obamacare — if the court rules against it and it collapses — then I think we need to offer solutions here in Congress,” said MacArthur.

The case puts Republicans in an odd little position. While the GOP continues to decry the health law and continues to try to repeal it at every turn, the party could get punished by its conservative base if it works to fix it. MacArthur says he’s willing to risk criticism if millions of Americans lose their federal subsidies.

“I’m more concerned about fixing the problem than any temporary confusion,” he said.

Fixing the problem seems easier said than done. While House Republicans have cast some fifty votes to repeal Obamacare, they’ve cast a whopping zero votes on a replacement plan because the party is divided on the subject. Sen. Pat Toomey (R-Pennsylvania) says critics of the GOP are asking the wrong questions.

“We don’t want the federal government to take control of the health care of the American people. So what I think you’ll see is a series of ideas that are all designed to enhance access and affordability,” said Toomey.

Republicans have floated ideas such as allowing people to shop for insurance across state lines and reigning in medical malpractice lawsuits. Toomey says Republicans like him who are up for reelection in 2016 need to fine tune their message.

“Well I think we need to continue to articulate an alternative vision for health care,” Toomey said.

While Republicans could outline a vision to replace Obamacare in the 2016 election, they likely can’t implement what’s on their health care wish list unless the GOP captures the White House. Rep. Pat Meehan (R-Delaware County) sits on the tax writing committee and says he’s readying a Plan B to possibly provide temporary tax breaks to people if they lose their health insurance subsidies.

“It can and that’s why there’s a desire to communicate that there’s a readiness to try to make sure that there’s a safe hand-off in the event of that,” Meehan said. “It’s not just going to erupt into chaos — that’s the thinking coming out of the Committee to send the signal that there’s alternative. There’s real alternative that could be put into place.”

The court won’t release its ruling in the King v. Burwell case for months. That gives both parties time to prepare for millions of Americans losing the insurance they just got.