Plenty of people have developed long-range proposals for killing the Patient Protection and Affordable Care Act (PPACA), replacing it, or tweaking it, by getting a bill, or a package of bills, through Congress.
The country may need a short-term fix faster than that if the U.S. Supreme Court rules against the Obama administration in the King vs. Burwell case.
The court will hear oral arguments on the case Wednesday and is expected to rule on the case by late June.
PPACA opponents say the U.S. Department of Health and Human Services (HHS) has no authority to provide PPACA premium subsidies for consumers in states with HHS-run exchanges. A ruling against HHS would not kill PPACA directly, but it would deal the PPACA commercial health insurance rules a devastating blow, by taking away the ability of moderate-income people in states with HHS exchanges to pay for individual medical coverage that meets PPACA coverage standards.
By taking young, healthy, moderate-income people out of the individual health insurance risk pool in those states, a ruling against HHS would probably make individual coverage unaffordable even for relatively high-income residents. If some sick people in the HHS exchange states moved to states with state-based exchanges to get access to premium subsidies, and PPACA-compliant plans sold without regard to the applicants’ health states, the flood of high-cost patients into states with state-based exchanges could destroy the individual major markets in those states, too.
Three top Republicans have proposed replacing PPACA with the Patient Choice, Affordability, Responsibility and Empowerment (Patient CARE) Act — a bill that would keep some popular PPACA provisions, such as some access to coverage on a guaranteed-issue basis, and a ban on lifetime benefits limits, but get rid of the individual coverage mandate.
Dr. Benjamin Carson, a possible 2016 Republican presidential contender, has proposed replacing PPACA with a health savings account-based system.
Louisiana Gov. Bobby Jindal, another possible 2016 Republican presidential contender, has said that, once Republicans kill PPACA, whatever comes next should look nothing like PPACA. “We don’t need Obamacare lite,” Jindal said, according to a Bloomberg report.
But, if the administration loses the case, whatever the U.S. health care system does in 2016, what does everyone do in late June 2015, while waiting for Congress to come up with a King vs. Burwell fix?
For a look at some of the proposals that have surfaced, read on.
1. The Supreme Court could include emergency relief in its ruling.
Even if the Supreme Court rules against HHS, and decides that HHS has no authority under PPACA to provide premium subsidies, it could soften the effect of the ruling on exchange plan issuers and enrollees.
The court could let HHS officials establish a transition plan for current enrollees, for example, or have the ruling apply only to PPACA exchanges that become HHS exchanges after a certain date.
2. HHS officials could try declaring that the current system will stay in place until the end of the calendar year.
HHS Secretary Sylvia Burwell and other HHS officials have refused to talk about whether HHS has any contingency plans in place that the department could use if the Supreme Court rules against it.
If HHS does lose, and the Supreme Court and Congress fail to give Burwell explicit authority to create a transition program, Burwell might be able to run with the ball, anyway, and use her regulatory authority to create an emergency fix.