I spent a good chunk of last week reading and summarizing the five Republican plans to fix Obamacare if the Supreme Court rules against the law. It was an ... educational experience. Now that I understand how, exactly, various Republicans plan to respond to Obamacare's insurance subsidies disappearing, I'm more convinced that Republicans as a whole won't pass any plan at all.
The problem is that all five Republican plans try to fix Obamacare and repeal Obamacare at the same time. The result is that all five plans try to fix a political problem for Republicans — the Supreme Court, at the behest of the Republican Party, has just ripped insurance from millions of Americans — by creating a new political problem for Republicans.
The core problem here is that the Republican plans are trying to restore Obamacare subsidies that Republicans actually want to eliminate. So they have to show they're anti-Obamacare in other ways, by doing things like repealing the individual mandate or the ban on preexisting condition discrimination. But those changes will unleash another sort of chaos on the market — undercutting the whole motivation for taking action in the first place.
Indeed, the irony of many of the Republican plans is that they create the exact disaster scenario health-care observers worried about with the 2012 Supreme Court ruling: a health reform law without an individual mandate.
Under Republican plans, premiums would still spike — and the individual market would still shrink
Sen. Ron Johnson's plan would end the individual mandate. So would the proposal from Reps. John Kline, Fred Upton, and Paul Ryan. Rep. Tom Price's goes a step further, repealing the individual mandate and the ban on preexisting conditions.
Health economists universally agree that without an individual mandate, Obamacare premiums would increase (they do quibble over the amount, ballparking it anywhere from 2 to 40 percent). This is why the 2012 ruling on the Supreme Court's individual mandate was such a big deal: it threatened to get rid of a policy crucial to keeping Obamacare's premiums affordable.
Without the individual mandate, young and healthy people would likely flee the market — with relatively low health-care costs, they don't have an especially strong motivation to purchase coverage. Premiums would skyrocket, and the market could easily go into a "death spiral," with increasingly sick enrollees who have really high medical bills signing up.
This is what the Republican plan to fix Obamacare would look like: replacing one type of chaos in the individual market with another.
Republicans don't want to fix Obamacare
Republicans could, hypothetically, pass a much simpler piece of legislation: one that just restores subsidies without changing other parts of the law. Legislators have made it increasingly clear they do not plan on doing that.
Let’s be clear: if Supreme Court rules against Admin, Congress will not pass ‘one-sentence’ fake fix #KingvBurwell http://t.co/0gEjvK3SZC— Sen. John Barrasso (@SenJohnBarrasso) June 8, 2015
Alternatively, legislators could try to kill off some program not related to the insurance expansion — the medical device tax and the Cadillac tax are often two popular repeal targets.
But those wins aren't as big for Republicans, so legislators have set their sights on bigger prizes, like the much-detested individual mandate.
If these twin goals of fixing Obamacare and replacing Obamacare remain intertwined, it's hard to see what legislators have to win from passing these plans. They'll prevent the premium spikes that would happen if the subsidies disappear — and replace them with the premium spikes that happen when young people disappear. And if chaos is the inevitable result of either situation, why bother passing anything at all?
And they still don't know what to replace Obamacare with
Speaking on the Senate floor last month, Sen. Christopher Murphy summarized the Republicans' response plan to the eventual King ruling with a powerful symbol: the internet's much-beloved shruggie.
As flip as the symbol it is, it's not a terrible way to summarize the Republican plans' for handling an anti-Obamacare ruling. Most of them include a few years of transitional subsidies, to help prevent chaos in the individual market with millions losing financial help at a moment's notice.
But after that? Well, that's where it gets pretty ¯\_(ツ)_/¯. In the Johnson plan, for example, there's a proposal to extend subsidies for an additional two years, through 2017. But there's no plan for what happens after that. It doesn't prevent chaos; it delays chaos for two years.
One assumption embedded in these proposals is that Republicans will come up with a plan to repeal and replace Obamacare — they just need a little more time. But Republicans have had five years to come up with an Obamacare replacement, and they have nothing to show for it. It's getting a bit hard to believe their replacement plan is still just around the corner.