- The Washington Times - Sunday, May 17, 2015

The list of Republican plans to deal with the potential fallout from a pivotal Obamacare case before the Supreme Court is growing longer, although Republicans have yet to coalesce around a game plan with just six weeks before the court is expected to rule.

The justices will decide by the end of June whether the IRS is unlawfully distributing Obamacare subsidies to people who use the federally run health care insurance exchange. The law offers tax credits to exchanges “established by the state,” but the administration insists that Congress intended to help all Americans, no matter where they live.

If the subsidies are struck down, President Obama will blame Republicans for cheering on the lawsuit and demand a quick extension of subsidies to all 50 states so more than 6 million people will keep their coverage.

Republican majorities in Congress instead have forged a patchwork of alternatives to rescue Americans affected by the case, known as King v. Burwell, so they aren’t blamed for the fallout.

They added two more plans in recent days. One is a comprehensive replacement for Obamacare from a senior House member, and the other would let states either stay the course or opt into a system that allows consumers to use a block of health care funds as they see fit.

“The Republicans are divided over what to do,” said G. Terry Madonna, a politics professor at Franklin and Marshall College in Lancaster, Pennsylvania. “There is no easy solution.”

House Minority Leader Nancy Pelosi, California Democrat, said Republicans risk political ruin if they spurn a quick fix to the Affordable Care Act — all that’s needed is a phrase or two — but Republicans insist they are on the right path.

“I think it’s important we put a positive solution and patient-centered solution out there, and I think we’ll be able to do so and will do so,” said Rep. Tom Price, a Georgia Republican who filed a revamped version of his replacement bill last week.

His bill would repeal Obamacare entirely and leave states in charge of Medicaid instead of expanding it and scrapping mandates that require Americans to hold insurance or buy policies with government-specified standards. It would offer tax credits to people who purchase insurance on their own on the individual market, although the latest version bases the credits on age instead of income.

Another plan, by freshman Sen. Bill Cassidy, Louisiana Republican, would give states three ways to respond to a ruling that strikes the subsidies. States could set up exchanges under Obamacare, do nothing and lose federal support or — and this is what the senator wants — opt into a third path titled the Patient Freedom Act.

“When I campaigned to represent Louisiana in the Senate, I promised that I’d fight for a free market alternative that gives doctors and patients — not government bureaucrats — the power,” Mr. Cassidy said in a Friday email to supporters.

His proposal would scrap Obamacare’s mandates and offer either state block grants or federal tax credits to help people access care. The money would go directly to the patients — not insurers, as Obamacare tax credits do — through health care savings accounts, a tax-advantaged fund that conservatives support because they feel it forces patients to draw from their health care dollars wisely.

The Louisianan said his plan could complement other solutions, such as a proposal by Sen. Ron Johnson, Wisconsin Republican, to lock in Obamacare’s subsidies through 2017.

If the court rules against Obamacare subsidies, states could let their residents rely on the Johnson plan in the immediate aftermath and then turn to his proposal when their legislatures meet.

Thirty-one Republican senators, including Senate Majority Leader Mitch McConnell of Kentucky, have co-sponsored Mr. Johnson’s bill, which would eliminate Obamacare’s mandates on individuals and employers but allow its subsidies to continue to flow to existing customers until Republicans have a chance to win the White House.

Freshman Sen. Ben Sasse, Nebraska Republican, also wants to offer financial assistance to people affected by King, but outside of Obamacare’s framework, so states are not tempted to embrace the law.

Under his transition bill, Americans affected by the court’s ruling could keep their Obamacare coverage during an 18-month grace period, akin to the COBRA health insurance law (the Consolidated Omnibus Budget Reconciliation Act) for people who leave or lose their jobs. The government would cover 65 percent of their premiums for the first six months before phasing down assistance 5 percent each month until it disappears after another year.

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