The House Republicans’ Obamacare lawsuit is a prime example of why it will be so hard for them to repeal the healthcare law.
At stake are subsidies helping more than 6.3 million Americans pay for out-of-pocket costs associated with their health plans. A federal judge sided with Republicans earlier this year, saying the Obama administration can’t award the cost-sharing subsidies without an appropriation from Congress, which lawmakers have refused to grant.
But that victory presents Republicans with a hard choice, now that President-elect Trump is headed to the White House: whether to allow the payments they previously opposed or whether to deprive people of the subsidies and risk losing political capital.
“This is a really tough issue for them, and it goes to the larger point, which is governing is actually quite hard,” said Bill Pierce, senior director of Apco Worldwide and a former official at the Department of Health and Human Services. “The issue is much more complicated because now they own everything.”
Millions of people who buy Obamacare marketplace plans qualify for cost-sharing subsidies to help them pay for elements such as co-payments and deductibles, expenses that can add up to thousands of extra dollars. The qualifying income threshold to receive a cost-sharing subsidy is $11,880 to $29,700 for an individual and $24,300 to $60,750 for a family of four.
The highest concentrations of Americans with cost-sharing subsidies live in states that voted for Trump. Out of the 15 states with the highest share of consumers with the subsidies, only three went for Trump’s opponent, Democratic nominee Hillary Clinton.
More than 70 percent of marketplace consumers have cost-sharing subsidies in Mississippi, Alabama, Florida and South Carolina, home to Republican voters whom lawmakers won’t be eager to anger.
House Republicans likely weren’t envisioning this scenario when they filed the lawsuit in 2014. At the time, they were trying to undermine the Obama administration’s ability to implement the Affordable Care Act.
The administration appealed a ruling earlier this year from Judge Rosemary Collyer in which she upheld the House challenge to the subsidies. But on Monday, the U.S. Court of Appeals for the D.C. Circuit put the lawsuit on hold until after Trump takes office.
It’s unlikely a Trump White House would continue the appeal, virtually guaranteeing the decision will stand and putting Republicans between a rock and a hard place. House Speaker Paul Ryan’s office didn’t respond to a question about whether Congress will allow the cost-sharing subsidies to keep flowing next year.
The issue is a microcosm of Trump’s and Republicans’ larger Obamacare dilemma.
About 20 million Americans have health coverage because of the Affordable Care Act, either through expanded Medicaid or through private marketplace plans, most of them federally subsidized. Those Americans would likely lose their coverage if Republicans repeal the law without replacing it.
Republicans are contemplating an approach that would involve voting quickly to repeal the law but delaying its final demise for a few years while they try to craft a replacement.
CSR National Map by Daniel on Scribd
