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What Happens if the Court Goes ACA Troofer?


One thing we do know, some especially gullible moderate Republicans and perhaps pundits notwithstanding, is that Congress isn’t going to do anything. The more interesting question is how this will play out for the GOP. Jamelle Bouie argues that there will be some negative potential consequences:

For an ideological team trying to win, this is smart strategy. But for a political party trying to prove its mettle ahead of the next election, it’s terrible, irresponsible behavior. It’s also self-defeating. Thirty-six states don’t run exchanges and they’re mostly led by Republican governors and statehouses. And of the 5.4 million middle- and working-class people who buy insurance on those exchanges, 87 percent receive subsidies. In other words, even if Congress doesn’t act, Republicans will still be responsible for cleaning up the mess.

This is one reason why some Republicans are beginning to wonder what the party does if the King challengers win. “We’ve got a number of Republican senators who are talking,” says Tennessee Sen. Lamar Alexander, who chairs the Health, Education, Labor, and Pensions Committee. “We are talking with Reps. [Paul] Ryan and [Fred] Upton in the House. We want to be responsible about repairing any damage that Obamacare does. If it creates a shock to the system by causing 5 million Americans suddenly to put their insurance and their subsidies at risk, then we need to think if there’s anything we need to do.” Then again, Alexander continues, “Maybe there’s not.”

Maybe there’s not. That, I think, is the nut of the issue. For as much as there’s some Republican concern for the consequences of King vs. Burwell—even as they cheer the challengers—there are many more in the party who don’t care enough to bother with an alternative. All that matters for them is the win. Or, as North Carolina Sen. Richard Burr told Politico (in a voice that sounds flippant on the page), “As far as I’m concerned, if King vs. Burwell is struck down, the White House is the one responsible to say what they’re going to do next. … They’re the ones between a rock and a hard place because this is their plan.”

The last point is important. Even if there is a political risk, this doesn’t mean that Republicans won’t let the exchanges get wrecked. Just as some Demcocrats took a hit for passing the ACA (and were right to do so, because the point of winning elections is to do stuff), Republicans who are opposed to the idea of helping people without medical insurance will be willing to take some political risk to severely damage the ACA, and while their values are repugnant you can’t fault their strategic calculus per se.

That said, I’m not sure how much political risk there will be. At the federal level, I think there will be very little. Obama is likely to take the primary blame for the failure of “Obamacare” no matter who’s really responsible. Perhaps congressional Republicans will take a little hit as they fail to pass what would be an easy fix, but I certainly don’t think it would be enough to threaten their control of the House in 2016.

At the state level, I agree that it’s a little more complicated. It will in most cases be Republican governments that are unwilling to set up exchanges, and this will hurt some middle class people. But I’m still not sure what the political hit will be. Some states are so solidly red that there’s almost nothing Republicans can do to lose. There might be problems in more marginal states, but again this relies on low-information voters to correctly assess blame for a problem that still only affects a minority of voters. I hope I’m wrong, but I think Republicans would be able to stand by and do nothing as a Republicans in black robes wreck the exchanges and largely get away with it.

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