The day after the congressional midterm elections handed the Republican party control of Congress and kept Senator Mitch McConnell and House Speaker John Boehner in congressional leadership positions, the two GOP lawmakers penned an opinion piece for the Wall Street Journal that promised to renew the party’s “commitment to repeal Obamacare, which is hurting the job market along with Americans’ health care.” With the House conducting its 56th vote to repeal the Affordable Care Act, all the GOP lawmakers that have campaigned on a pledge to ax Obamacare have made good. The House resolution, which would essentially gut the health care reform, garnered the approval of nearly every single one of the 246 Republican representatives on Tuesday, passing by 239 votes to 186. The only Republicans to cast “no” ballots were Reps. Robert Dold of Illinois, John Katko of New York, and Bruce Poliquin of Maine, who believe the GOP should focus its attention on a workable alternative to the health care reform.
“For too long the American people have been hurt by the President’s disastrous health care law – they’ve seen their premiums skyrocket, they’ve lost their coverage, and they’ve lost the freedom to choose the plans that best fits their needs. Today House Republicans voted to pave the way for real, patient-centered health care reform, and to repeal a law that continues to harm Americans in every corner of this country,” read a GOP press release issued after the vote.
If this feels like Groundhog Day, that’s because it is. Despite the Republican’s 54-seat to 44-seat majority in the Senate and huge presence in the House, the vote was largely meaningless. President Barack Obama will never sign a repeal of his signature legislation, and Republicans do not have a large enough majority to overturn a presidential veto. The House resolution is not even expected to pass the Senate. The Atlantic’s Russell Berman describes the largely symbolic vote:
They’re doing it for the freshmen — that is, the 47 House Republicans who just took office a month ago and have never had the high honor and privilege of voting to repeal Obamacare. By holding the vote, these lawmakers can head back to their districts and tell their constituents that yes, they did everything they could to get rid of the reviled law.
A GOP aide even said, “We’re just getting it out of the way.” That sentiment is clearly shared by the Republican leadership, including Boehner who told Fox News host Bret Baier that the party was giving those 47 freshman lawmakers the chance to voice their dislike of the law.
February 3 was just another day of political posturing. The expanded Republican majority delivered constituents another repeal attempt. Only hours earlier, President Obama hosted a prettily packaged publicity opportunity — a reception in the intimate Roosevelt Room in the White House to honor 10 “ordinary” Americans who had written testimonials to the benefits of the Affordable Care Act, which prove that the law is “not an abstraction,” as the official release stated. Newly elected and reelected GOP leaders, particularly McConnell, who easily kept his seat and was chosen to serve as Senate Majority Leader, admitted that voters had spoken their disapproval of “governing by crisis” and promised to restore proper legislative function and productivity to Washington. Pursuing a vote on legislation that will never be passed into law as long as Obama remains in the White House, only so that new Republican lawmakers have the opportunity to take a symbolic stand against a law benefiting a sizable chunk of the party’s constituency, hardly seems productive.
For years, Republicans have doggedly pursued the “repeal” part of its “replace and repeal” agenda. But they are clear on their criticisms: the health care reform is hurting the economy, hurting Americans’ job prospects, and hurting the U.S. health care delivery system while driving up health care costs, to paraphrase Boehner on his most-recent Fox News appearance. Although, at least in their rhetoric, the party does acknowledge some solution must be found to put the brakes on the United States’ ballooning health care spending.
“While both parties agree that we must make health care more accessible, we in the majority fundamentally disagree that more government is the answer,” stated House of Representatives Majority Leader Eric Cantor in May of 2013, as the Republican party pushed to repeal the Affordable Care Act before the implementation of its cornerstone provision — the individual insurance exchanges. His comments are noteworthy for the fact that he admitted the American health care system not only needed a fix, but needed to be made more accessible. Since that statement was made on the floor of the House, the insurance marketplaces have launched, and criticism has been dumped on the Obama administration for the initially poor performance of the federal health care website and for the cancellation of millions of so-called non-compliant insurance policies. The ongoing fear the law will damage the United States finances continues to circulate and it remains deeply unpopular with the public.
But the fact remains that Republican party has yet to find any alternatives to the health care reform that has already brought coverage to 10 million Americans through subsidized insurance and the expansion of Medicaid. According to a recent estimate from the Congressional Budget Office, by year’s end that number will rise to 19 million people. Unlike when previous attempts to derail the implementation of the Affordable Care Act were made, the health care reform is now no easy matter to unravel. That reality makes the House Republicans vote an important milestone in the party’s campaign against Obamacare; for the first time, casting a ballot in favor of repeal means taking away coverage from millions of Americans and eliminating a program that largely benefits their own constituents. A recent study has show that 60% of Obamacare beneficiaries receiving federal insurance subsidies are from the American South, a region quickly becoming a Republican bastion. And, 60% of those with subsidized insurance coverage are non-Hispanic whites. The last time the House voted to repeal the law in its entirety came on May 16, 2013 — when the first enrollment period was still almost five months away and GOP opposition could still be framed in terms of political philosophy. Then, not a single Republican cast a “no” vote.
With this vote to repeal, Republicans do hold more seats, both in the House and the Senate. But a number of the Republicans that November’s congressional midterm elections swept into office won in swing districts, which could easily return to Democratic hands in 2016. Carlos Curbelo, whose district includes the western suburbs of Miami, in which are some of Florida’s poorest communities, is one such representative. His heavily Latino district hosts the zip code with one of the highest Obamacare enrollments in the United States. Curbelo gave the Republicans’ Spanish rebuttal to Obama’s State of the Union Address, and his words serve as a perfect case study of the tensions rippling through the Republican party. While Iowa Republican Senator Joni Ernst, in the party’s English response, called Obamacare one of the president’s “failed policies,” Curbelo spoke about the income gap. He criticized lawmakers for not working “toward a health economy that offers opportunities to everyone who lives in this country, not just the most privileged,” rather than bash the health care reform.
While it remains true that any legislative attempt to repeal the Affordable Care Act during Obama’s presidency is doomed to failure, the future of the reform is uncertain. Last summer, two lower courts returned opposing rulings on the legality of the government subsidies, the element that creates affordable health insurance. That split decision prompted the Supreme Court to take up the case, leaving the 9-justice panel to decide whether Congress meant to provide federal subsidies to both Americans who purchased insurance coverage through the exchanges set up by the states and those who bought plans via the exchanges designed and operated by the federal government on behalf of 36 states.
The text of the 2010 law states that the Internal Revenue Service (IRS) can authorize subsidies to qualifying insurance consumers who purchase policies through “exchanges established by the state.” These are awarded to Obamacare enrollees with annual incomes of up to 400% of the federal poverty level in the form of tax credits.
For Obamacare critics, these four words, “established by the state,” exclude the 36 states in which the federal government, rather than the state, operates the online insurance marketplaces from subsidy provision. But in 2012 — after the passage of the law and the Republicans gained control of the House of Representatives — the IRS did adopt a regulation that allowed individuals who qualify for the subsidies but live in states that defaulted to the federally facilitated exchanges to receive the tax credit, “regardless of whether the exchanges is established and operated by the state.”
Congressional Republicans will most likely oppose restoring the tax credits if the Supreme Court rules that the federally facilitated exchanges, which were initially intended to only be a fallback, cannot not distribute subsidies. And Obama will be powerless to take any executive action in response to the court’s ruling.
If the court rules that the law only allows for insurance purchased through the state-run exchanges to be subsidized, Obamacare would be effectively destroyed. The Rand Corp. reported that if the subsidies for federal exchanges are eliminates, “individual market enrollment would decline by more than 70 percent, or 9.6 million,” and the unsubsidized individual premiums in those exchanges would increase by 47%. Such a decision would be welcomed by Republicans, and the Supreme Court-mandated dismantling of the Affordable Care Act is actually possible. However, the chance that such a ruling could be handed down makes it all the more necessary for the GOP to craft an Obamacare alternative. The court is expected to come to a decision in June.
Republicans have only taken a few miniscule steps toward that goal. In the House, Ways and Means Chairman Paul Ryan, Energy and Commerce Committee Chairman Fred Upton, and Rep. John Kline (R-Minn.) have formed a task force to design a replacement. In the Senate, Lamar Alexander, Orrin Hatch, and John Barrasso are pursuing the same goal. But still nothing definitive has coalesced.
At a January Republican retreat, Ryan and Upton did discuss strategy. “They talked about it in a broad sense — not in any real detail,” as Louisiana Rep. John Fleming told Time. “We just agree that if this thing goes down in the Supreme Court than we’re going to have to come back with something.” And while he noted that “they’re going to be people that are unhappy with us because some people are getting subsidies and they like them,” Fleming did not disclose a solution for those Americans who “want to keep” their coverage.
For now, despite the 56 votes, three elections, six years of debate, and two Supreme Court rulings, the Republican party has no alternative.
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