Obamacare: You break it, you buy it

Obamacare exchanges challenged in Supreme Court
Obamacare exchanges challenged in Supreme Court

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Story highlights

  • Ford Vox: Democrats made errors in rush for Obamacare, but provided wide public access
  • Vox: Republicans are pushing a case that would upend Obamacare, but their alternative would be a disaster

Ford Vox is a physician specializing in rehabilitation medicine and a journalist based in Atlanta. He writes frequently for CNN Opinion. Follow him on Twitter @FordVox. The opinions expressed in this commentary are solely those of the author.

(CNN)The President repeated an unfortunate and ill-fated claim while campaigning hard for Obamacare. You remember it. "If you like your health care plan, you can keep it."

Ford Vox
With that false sloganeering, Barack Obama made sure he thoroughly owned a piece of the scorn spawned every time an insurance company changed or canceled plans after the ACA became law. Bad move. He's apologized, but history will record the affair as his "Read my lips, no new taxes" moment
Yet, there are worse moves politicians can make. Republicans are making one now.
    Republican leaders are stepping up to offer woefully inadequate stand-ins for Obamacare. They're offering these salves because they're hoping the Supreme Court issues a death blow to the federal exchanges that are now facilitating health coverage in 37 states and they want to have a possible alternative.
    There is plenty of potential the case, King v. Burwell, will succeed in halting the insurance subsidies that federal exchanges require to function. The Republican leadership is smart. They understand some of the anxiety already percolating up now could transform into a true panic. But in trying to contain fear, they're guaranteeing they'll own the anger that comes next.

    GOP 'blueprint' alternative

    A collection of three congressmen, including Senate Finance committee chair Orrin Hatch (R-Utah), recently acknowledged the dire need for an alternative in the wake of Obamacare's demise and issued a "blueprint" that nods toward some of the key concepts.
    Rather than subsidize the cost of heavily regulated insurance plans, this proposal would free up the market more, including more price variability, and offer tax credits to help defray the cost for people making up to three times the poverty level.
    In place of Medicaid expansion, the Republican plan would cap the federal Medicaid support, linking it to the Consumer Price Index. The plan effectively kills universal access by offering people a one-time chance to sign up for coverage, and it doesn't require that anyone obtain coverage, making the individual insurance market unsustainable yet again as primarily those who already know they're in ill health will flood the market and premiums will become unaffordable.
    If anything, the massive outreach campaigns required to push traffic to HealthCare.gov demonstrate the difficulty in getting young, healthy people to act in their own best interests.
    While this outline potentially salvaged some semblance of the broad health care access the ACA is achieving, Senator Hatch showed his hand with a subsequent Washington Post op-ed he shared with two other senators.
    Insisting that "Republicans have a plan to help Americans harmed by the Administration's actions," you might be forgiven if you didn't realize the harm was simply enforcing one's civic duty to purchase affordable health insurance. Instead, Hatch and his colleagues hope to soften the blow by offering a transitional period so that marketplace health plans aren't immediately canceled after the Supreme Court issues its ruling, expected in June.
    The senators would generously allow states to develop their own plans, something only the intellectual powerhouse of Massachusetts managed to accomplish prior to the ACA. With most of the affected 37 states having one or more government branches controlled by a party that preferred the status quo prior to the ACA, such state-level innovation isn't likely.
    Louisiana governor and distant Republican presidential hopeful Bobby Jindal advocates a starker response: let's roll out the welcome mat for the apocalypse.
    He argues that canceling the subsidies in all 50 states would reduce taxes by $48 billion, so canceling them in 37 states is a great start. Jindal actually thinks the Supreme Court's potential decision against the ACA presents Republicans with an electoral "solution" -- the chance to bask in the glory earned by a massive tax cut.
    The White House got a bit desperate in the run up to Obamacare, that much is clear from the poor vetting they applied to President's own stock stump speeches. Beyond his unclear rhetoric, they pushed the law through both chambers of Congress hurriedly and didn't allow it to receive the normal careful editing and revisions in a joint committee.

    A flaw in Obamacare

    The President leaped to sign the bill, warts and all, as it very well could have flitted away altogether. Now one of those warts has turned cancerous. It surprised everyone involved with debating and covering the ACA at the time of its passage, including the lawyers behind this suit, to learn the bill erroneously specifies only state-run exchanges can dole out subsidies. Yet in their giddiness over the law's potential demise over its own inconsistencies, the Republicans are getting sloppy too.
    The case is driven by a small nonprofit outfit called the Competitive Enterprise Institute, which while it has tentacles throughout the Republican establishment, means that the case itself, at one point, couldn't be blamed as the GOP's own strategy.
    But now that multiple Republican leaders have stepped up to offer these farfetched fix-it plans, and several leaders have even supplied the court with amicus briefs in support of the plaintiffs, there's simply no separating the GOP itself from the Supreme Court's decision in King v. Burwell.

    You won't be able to keep any plan

    Republicans aren't promising that you can keep your plan if you like it. They're promising, that for millions of Americans now receiving their health care through the federal marketplace, you won't be able to keep any plan at all.
    Over 9 million people would lose health insurance altogether if the plaintiffs win in King v. Burwell, and many more will suffer due to the destabilized markets that in many cases will shut down altogether as rates skyrocket and insurers pull out.
    None of the Republican plans can realistically come together to fill the gap anytime soon, so a gulf will emerge between states with the political will to operate their own exchanges and the red and purple states that don't have such fortitude.
    We suffered a rocky transition into the ACA, no question, but hospital systems, providers and patients are just now getting the lay of the land.
    We are seeing some great advantages, particularly in fields like mine. In rehabilitation medicine, we're seeing that serious injuries that once blocked access to insurance are no longer a barrier. The White House isn't making the mistake of owning what comes next. They're frank: there are no contingency plans.
    Republicans, apparently, want to own the next wave of insurance cancellations, while refusing to make a simple edit to a bill that for once guaranteed health care for the poor, injured and disabled. So be it -- 2016 is in sight.