GOP Lawmaker Presses Party Leaders for ACA Subsidies Backup Plan

On Monday, Rep. Bruce Poliquin (R-Maine) sent a letter to Republican leaders asking them to develop a contingency plan in case the Supreme Court strikes down the Affordable Care Act's subsidies to help U.S. residents  purchase coverage through the federal exchange, The Hill reports (Ferris, The Hill, 5/18).

Background

The subsidies are being challenged in the case King v. Burwell. The high court heard oral arguments in the case in March and will release a decision by the end of June. If the court strikes down the federal exchange subsidies, the ruling would eliminate about $28.8 billion in subsidies to 9.3 million individuals in 34 states in 2016, according to an Urban Institute analysis. GOP lawmakers in Congress have proposed various contingency plans that would respond to a ruling striking down the subsidies for federal exchange costumers (California Healthline, 4/22).

According to The Hill, it is still unclear whether Congress will implement a contingency plan if the subsidies are ruled illegal.

Letter Details

In the letter to House Ways and Means Committee Chair Paul Ryan (R-Wis.) and other committee leaders, Poliquin wrote that if the subsidies are struck down, Congress must "create a thoughtful free-market replacement for" the ACA that provides "an off-ramp for the six million individuals who have in good faith purchased Obamacare policies."

He proposed a plan with no individual mandate and no requirements that health plans meet the ACA's minimum coverage standards. In addition, Poliquin suggested that physicians must provide patients with estimated service costs so that individuals can "shop around." Further, the plan would allow U.S. residents to purchase coverage across state lines. The plan also would bar insurers from using pre-existing conditions as a basis to deny coverage, similar to the ACA.

Poliquin also warned against implementing a backup plan that would require states to create their own exchanges so their residents could receive the subsidies under the law. He cited Maine's "failed state-run health insurance experiment," which he noted was similar to the current state-run exchanges (The Hill, 5/18).

GOP Lawmakers Might Not Use Reconciliation for ACA Subsidies Fix

In related news, Republican lawmakers might not use the budget reconciliation process to consider a contingency plan if the Supreme Court rules the subsidies are illegal, CQ News reports (Krawzak, CQ News, 5/18).

Congress earlier this month adopted a joint GOP budget agreement that would allow the Senate to use the budget reconciliation process to attempt to overturn parts of the ACA. Budget reconciliation allows budget bills to be passed by a simple majority. Doing so would avoid legislative hurdles that Republicans typically would need 60 votes to bypass. However, reconciliation rules prevent Republicans from using it to pass a measure repealing the entire ACA. Under the agreement, a measure to repeal a portion of the ACA is scheduled to advance in July. Observers have speculated that Republicans could use the reconciliation measure to implement a contingency plan if the high court invalidates the subsidies (California Healthline, 5/6).

According to CQ News, there are several reasons why the GOP could avoid using reconciliation to move an ACA subsidies backup plan. For example, to avoid a veto from President Obama, any subsidy plan would need some Democratic support. However, enough Democratic support would eliminate the need for reconciliation.

Further, under reconciliation, any provisions that do not have a budgetary impact can be struck from the bill, limiting the extent to which the measure could address the ACA.

House Budget Committee Chair Tom Price (R-Ga.) has noted that negotiations among House Republicans seem to be leaning away from using reconciliation to pass a subsidies backup plan. However, Price said he does not "think that [a] final decision has been made."

Sen. Richard Burr (R-N.C.) also said he expects a subsidies contingency plan will be advanced through the usual legislative process. He noted such a plan could be formed in a way that draws Democratic support, but added that he doubts Obama would sign such a measure.

Senate Majority Whip John Cornyn (R-Texas) has said that a decision has not yet been made on reconciliation, but lawmakers are "working now to figure out the appropriate response." He added that reconciliation could be used for a full ACA repeal vote (CQ News, 5/18).