The GOP’s Health-Care Reckoning

by Karl Rove,

Obama and Clinton are waiting to pounce if the Supreme Court nixes federal subsidies.

If the Supreme Court holds in King v. Burwell that the Affordable Care Act—also known as ObamaCare—does not allow subsidies for health coverage to flow through federal insurance exchanges, Republicans better be ready to say what to do next. Under such a decision, roughly eight million Americans in three dozen states would lose subsidies worth thousands of dollars. Many would suddenly find it impossible to pay for the insurance plan they’re on now.

President Barack Obama will then accuse conservative justices of overreaching and demand that the GOP Congress immediately extend subsidies to every state. His message will be politically potent, as it will turn the words of Republicans in 2013 back on them: “If you like your plan,” Republicans said, “you should be able to keep your plan.” Hillary Clinton will join in depicting Republicans as heartless brutes who would let people die for lack of health insurance rather than fix Mr. Obama’s law.

Fortunately, congressional Republicans have been thinking about the GOP’s response. The challenge will be to build consensus for one bill, choosing from the many ideas now being discussed.

The proposals that have been floated so far fall under two general approaches. The first emphasizes providing transitional coverage for those affected by the loss of subsidies, while replacing selected elements of ObamaCare. The second also includes transitional coverage but puts more emphasis on replacing and reforming ObamaCare. Both approaches are predicated on the belief that wholesale repeal and replacement of the law is impossible until a Republican is president.

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