It would have seemed unthinkable for Republicans to consider helping poor Americans get Obamacare subsidies a few years ago. They hate the Affordable Care Act and have sought repeatedly to wipe it from the books.
And should the Supreme Court uphold the King v. Burwell case in June, the low-income residents who stand to lose the most aren’t the GOP voting base anyway. Voters above the $50,000 income line tend to swing Republican, while those below tend to vote for Democrats.
The King case revolves around the question of whether the Obama administration can award subsidies in the 37 states relying on healthcare.gov instead of running their own insurance marketplaces. If the court decides it can’t, about 7.5 million Americans could lose federal assistance to buy health coverage.
Those not on Medicaid and earning up to four times the federal poverty level (about $47,000 for an individual and $95,000 for a family of four) can receive subsidies to varying degrees. The less people earn, the more subsidies they qualify for.
For example, someone with a $25,000 income buying a mid-grade silver plan with a $216 monthly premium would qualify for $73 in assistance. The subsidy would increase to $153 for someone earning $18,000 buying the same plan.
As they await the King decision, Republicans are considering legislation that would keep the subsidies — at least through the 2016 election— but which would also repeal the healthcare law’s individual and employer mandates, too.
Rep. Paul Ryan is working with Reps. Fred Upton and John Kline on a detailed plan, and at least four other GOP proposals are floating around. But President Obama is likely to veto any measure that goes beyond restoring the subsidies.
Preserving health insurance subsidies isn’t the most natural policy for Republicans. But with a Senate majority to defend and the White House up for grabs next year, they may have some good reasons to make some good-faith efforts:
1. The subsidies would be struck in nearly every red state.
More Republicans than Democrats could watch their constituents lose subsidies if King is upheld, suddenly making it harder for many people to afford their monthly premiums and putting them at risk for having their plans canceled.
That’s because a majority of the recipients live in conservative states that didn’t set up their own insurance marketplace.
The Affordable Care Act provides that if states opt out, the federal government runs their marketplace instead. Every Southern state and most of the Midwestern states took that route. Just 13 states and the District of Columbia fully operate their own exchanges, and with the exception of Colorado, Minnesota and Kentucky, they’re all near the East and West coasts.
2. The subsidies would be struck in swing states.
Iowa, Florida, Ohio and Virginia are among the 37 states relying on healthcare.gov. So are Arizona, North Carolina and Wisconsin. Nevada and New Hampshire are getting federal help with their marketplaces. The only swing state fully running its own exchange is Colorado.
Whoever wins the GOP nomination will need to compete in those states — and he or she could face blame from Democrats if the Republican Party doesn’t take serious steps to restore subsidies should the court strike them.
3. Republicans need low-income voters … sort of.
Republicans struggle to win over low-income voters. They can sometimes win elections without poorer voters if they get their base — white, middle and upper-income voters — to turn out.
George W. Bush lost among those with household income below $40,000 in both of his presidential victories. Last year, Bill Cassidy and Thom Tillis won their Senate races in Louisiana and North Carolina despite losing among voters with incomes less than $50,000.
But most of the Republicans who emerged victorious from tight Senate races won over the working poor — those earning between $30,000 and $50,000. Those include Cory Gardner in Colorado, Tom Cotton in Arkansas, Joni Ernst in Iowa, Mitch McConnell in Kentucky and Shelley Moore Capito in West Virginia.
Low-income blacks overwhelmingly vote for Democrats, but Republicans have better chances among whites — if they can figure out how to appeal to them.
“I think we need to increase our share, clearly,” said Ed Gillespie, former chairman of the Republican National Committee. “To win — absolutely.”
If the court upholds King, many working-class whites stand to lose Obamacare subsidies if Republicans don’t save them. Sixty-five percent of enrollees on healthcare.gov were white compared with 14 percent who were black, according to enrollment data from the Department of Health and Human Services.
4. Americans want Congress to protect the subsidies.
Public opinion might be another reason for Republicans to extend the subsidies. People don’t want to lose government benefits they’re already receiving, and Obamacare tax credits are no different.
Fifty-four percent of respondents to an NBC/Wall Street Journal poll in February said Congress should pass a law preserving the subsidies, while 35 percent said it shouldn’t. The poll found that majorities wanted the subsidies saved, regardless of income level.
And that is factoring into Republicans’ conversations. “Republicans have seen the polling,” one Hill aide said. “We’ve made a big deal out of the fact.”
