If GOP topples Obamacare, few will like what happens next

The hatred Wyoming GOP officials have for “Obamacare” could result in thousands of state residents losing affordable health insurance this summer if the U.S. Supreme Court rules in favor of a conservative challenge to the federal healthcare law.

Republicans have tried to repeal the Affordable Care Act since it was championed by President Barack Obama and passed by Congress in 2010. The GOP should be careful what it wishes for — the party may finally cripple Obamacare, but millions of Americans will be hurt, and the lawmakers who caused it won’t be able to fix this nightmare.

The question is whether conservative lawmakers even care about wrecking our national healthcare system, which is insuring more people and reducing costs that were spiraling out of control, despite bogus claims by opponents. Republicans may not pay any price in the 2016 elections for their terrible decisions, which is almost a certainty in Wyoming and other ultra-red states.

How are Wyoming officials responsible for potentially creating havoc in the state over healthcare? I’m glad you asked.

Under the ACA, Wyoming had a choice to either set up a state-operated health insurance exchange or let the feds run it. Despite the fact our leaders despise all things the federal government does (with the exception of the money it sends us), the state opted for the latter.

The Legislature followed the recommendation of the Wyoming Health Insurance Exchange Steering Committee, a 21-member panel created in 2011 to study health exchange options. In November 2012, Gov. Matt Mead said the state may eventually start its own exchange, but legislators then put everything on hold until the Supreme Court decided a lawsuit nearly half the states filed challenging the constitutionality of Obamacare — legal action Mead insisted Wyoming join.

GOP legislative leaders reasoned if the court threw out Obamacare, there would be no need to set up any health exchange. Instead of starting a state-run exchange by the ACA’s deadline, Wyoming waited. The Supreme Court upheld the new healthcare law, and the state squandered its opportunity to create its own exchange.

This decision was critical, because in March the high court heard an appeal orchestrated by a group challenging subsidies Congress approved for 34 states that chose federal exchanges, including Wyoming. Funded by the Koch brothers, oil and gas companies and Big Pharma, the Competitive Enterprise Institute claims Congress intended that only state exchanges can subsidize insurance policies.

If the court rules in favor of the four plaintiffs in King v. Burwell, it’s estimated about 8 million people will lose the health insurance they bought on the federal exchanges. Millions more whose premiums would increase by 35 percent or greater could either buy cheaper policies with inferior coverage or go without insurance.

The 13 million additional people now insured thanks to Obamacare will drop to 5 million — mostly made up of the working poor who were added to the Medicaid rolls in a majority of states. But none of those 5 million live in Wyoming, because the Legislature heartlessly chose not to expand Medicaid to include low-income, childless adults.

Wyoming lawmakers made sure nearly everyone who should benefit from Obamacare will lose.

Another loser will be the state’s hospitals, which are a combined $200 million in the red annually because of the cost of uncompensated care for those who would be eligible for Medicaid expansion but are left out in the cold. When they need healthcare, the working poor go to emergency rooms they can’t pay for, resulting in higher insurance premiums for the rest of the population.

A report by the Urban Institute of the Robert Wood Johnson Foundation estimates a ruling against the ACA will result in a $22 billion loss in healthcare spending nationally. Of that amount, hospitals are projected to lose about $10 billion.

I don’t know how much money Wyoming hospitals will lose, but it will be enough for more institutions to be threatened with closure.

There’s also the human cost of an anti-Obamacare decision. The Urban Institute and other health policy groups estimate nearly 10,000 people would die prematurely each year because of the lack of affordable healthcare. These citizens now have insurance coverage solely because of the ACA. They shouldn’t lose their lives because a think-tank thought of a dubious reason to challenge the federal exchanges.

Of the four plaintiffs in King v. Burwell, there may not be any who have actually been harmed by Obamacare. In an excellent article by Stephanie Mencimer in the Feb. 9 Mother Jones magazine, she reported three of the four will soon be eligible for Medicare, so they could not even obtain Obamacare subsidies.

A pair of plaintiffs actually paid far more for their current insurance than they would have under the ACA. Two of them also appear to qualify for hardship exemptions and would not be required to obtain insurance under the law.

Plaintiff Brenda Levy told Mencimer she didn’t realize the potentially devastating impact of her lawsuit.

“I don’t want things to be more difficult for people,” she said. “I don’t like the idea of throwing people off their health insurance.”

If the Supreme Court doesn’t want to destroy healthcare as we now know it, it could declare none of the plaintiffs has the standing to sue. That route could be taken by Chief Justice John Roberts, who saved the ACA during its earlier challenge by finding the individual mandate to buy health insurance was permissible as a tax.

Many legal experts believe the plaintiffs’ argument is weak because it relies on the court’s interpretation of a poorly-worded provision relating to federal subsidies. But this will be a political decision by a court that leans to the right a majority of the time. Conservative justices might look at the political message sent by their ruling instead of a correct, broad interpretation of the intent of Congress.

Some observers think the ruling may turn on whether the court is convinced Congress will come up with a quick remedy to put millions back on the insurance rolls.

It’s laughable to think Congress can do anything quickly, especially with stubborn Tea Party House members blocking all legislation that isn’t right-wing enough for them.

There are two competing House proposals in case the federal exchange subsidies are rejected, and both would give each state the power to decide how to run its own healthcare system.

Let’s see — First, the House and Senate would have to unite behind a single solution. Though the GOP controls both chambers, they have considerably different governing philosophies. Then there are the Democrats who are loyal to the ACA, who likely won’t hesitate to gum up the works just like Republicans did to obstruct Obamacare.

If Congress eventually approved a plan, it would have to be signed by the president. There would be a lot of pressure on Obama to do so, but he’s a lame duck who could contend the proposal won’t work as well as his own. Meanwhile, millions of people would continue to be without any insurance, or buy catastrophic plans with huge deductibles.

If the solution involves each state developing its own health care system, forget it. It’s way beyond the ability of many state legislatures to fix something so important with even a modicum of expediency.

I’d put Wyoming’s lawmakers in that category. In short order they decided to kill Medicaid expansion, which the state desperately needs.

But I doubt they could agree on how to build a state-controlled health care system without a couple of task forces, interim studies and blue-ribbon panels. Years could go by.

Then the legislator most responsible for killing Medicaid expansion — Sen. Charles Scott (R-Casper), co-chairman of the joint committee that considers health bills — might decide he doesn’t like the final product, and the entire effort would be back to square one.

It’s a worst-case scenario Republicans brought upon themselves.

— Columns are the signed perspective of the author, and do not necessarily reflect the views of WyoFile’s staff, board of directors or its supporters. WyoFile welcomes guest columns and op-ed pieces from all points of view. If you’d like to write a guest column for WyoFile, please contact WyoFile editor-in-chief Dustin Bleizeffer at dustin@wyofile.com.