On the fifth anniversary of the Affordable Care Act becoming law, there's value in reflecting on the systemic advances, which we did earlier. But it's also a good time to look ahead and consider where the policy fight is headed.
Congressional Republicans, for example, who've already voted literally several dozen times to repeal the law, released budget plans last week that would -- you guessed it -- uproot the American health care system, replacing it with an alternative that Republicans can neither explain nor identify.
As if that weren't quite enough, the GOP budget plans would likely double the uninsured rate, while eliminating $1 trillion in tax revenue that pays for the ACA. Because the Republican budget blueprint relies on bizarre gimmicks and fraudulent arithmetic, the plan offers no explanation for how it would cover the $1 trillion loss and no details about how Congress would help the millions of families that would lose access to affordable medical care after Republicans take their benefits away.
The GOP budget also makes no effort to address the possibility that Republican justices on the Supreme Court may soon scrap subsidies to consumers in two-thirds of the country in the ridiculous King v. Burwell case. House Ways & Means Committee Chairman Paul Ryan (R-Wis.), however, is on the case -- he doesn't have a policy solution, but Ryan has a plan to persuade state policymakers to help congressional Republicans' broader game plan.
Rep. Paul Ryan urged state lawmakers to resist setting up state insurance exchanges if the Supreme Court rules that key parts of the Affordable Care Act can only continue if they do so. "Oh God, no... The last thing anybody in my opinion would want to do, even if you are not a conservative, is consign your state to this law," the Wisconsin Republican told state legislators Thursday during a conference call organized by the Foundation for Government Accountability, a conservative think-tank.
Ryan reportedly went on to say, "If people blink and if people say, 'This political pressure is too great, I'm just going to sign up for a state-based exchange and put my constituents in Obamacare,' then this opportunity will slip through your fingers."
The right-wing Wisconsinite is known for some pretty extreme postures, but this is a brazen move, even for Paul Ryan.
If the Republican justices gut the Affordable Care Act, it's likely Americans would see a bifurcated system: consumers in states run by Democrats would continue to receive subsidies to afford quality medical coverage, while millions of consumers in Republican-run states would go without. Or put another way, if your state created its own exchange marketplace, very little will change. If your state has referred consumers to healthcare.gov to enroll, you and your neighbors may be in big trouble.
If the high court's ruling sides with the right, it's quite likely that some Republican-led states would scramble to create their own exchange in order to help their citizens. Indeed, leading GOP officials in states like Michigan and Ohio have already indicated an intention to do exactly that in order to prevent their constituents from suffering.
That's what Paul Ryan is responding to -- he's effectively telling these state officials, "No, wait, it's better to let your constituents lose their coverage. Helping families keep their coverage is what the White House wants, so don't do it."
And what about the "opportunity" Ryan mentioned on Friday? As the congressman sees it, if the Supreme Court sides with Republicans, and if states agree to let their citizens go without, then they'll be able to take advantage of the new GOP alternative to the Affordable Care Act. What's in it? Paul Ryan doesn't know. What will it cost? Paul Ryan doesn't know. How many people will it cover? Paul Ryan doesn't know. When can we see it? Paul Ryan doesn't know.
Why in the world would state officials listen to such ridiculous advice, putting their own constituents in jeopardy? Paul Ryan doesn't know -- and neither does anyone else.