As Supreme Court Weighs Health Law, G.O.P. Is Planning to Replace It

The legal campaign to destroy President Obama’s health care law may be nearing its conclusion, but as the Supreme Court deliberates over the law’s fate, the search for a replacement by Republican lawmakers is finally gaining momentum.

Senior Republicans in Congress hope that by June, the Supreme Court will invalidate the subsidies that 7.5 million Americans in 34 states have been given to purchase health insurance through the federal website But the prospects of legal victory have also raised practical and political fears that Republicans will take the blame for the health care crisis that would follow.

A legislative scramble is underway. On Monday, Representatives Paul D. Ryan of Wisconsin, Fred Upton of Michigan and John Kline of Minnesota, the chairmen of the powerful committees that control health policy, proposed what they called an “off ramp” from the Obama health act that would let states opt out of the law’s central requirements.

On the other side of the Capitol, Senators John Barrasso of Wyoming, Lamar Alexander of Tennessee and Orrin G. Hatch of Utah, all Republicans, offered their own plan this week to provide temporary assistance to those who would lose their subsidies and new freedom to all states to redesign their health care marketplaces without the strictures and mandates of the health care law.

Even a freshman, Senator Ben Sasse of Nebraska, proposed a major but temporary expansion of Cobra — the program that allows workers to extend their employer-based health benefits after leaving a job — to ensure that people do not lose insurance coverage as Washington rushes to find an alternative.

“Finally there are a whole bunch of people stepping up to the plate,” Mr. Sasse said on Thursday.

These bridge plans would evaporate if the Supreme Court sides with the administration, but many of their ideas — and even broader plans that are emerging — will live on regardless of the court’s decision.

Aides to senior House Republicans said Thursday that committee chairmen were meeting now to decide whether a budget plan — due out the week of March 16 — will include parliamentary language, known as reconciliation instructions, that would allow much of a Republican health care plan to pass the filibuster-prone Senate with a simple majority.

Representative Tom Price of Georgia, the House Budget Committee chairman, said that reconciliation language would be kept broad enough to allow Republican leaders to use it later, to pass health care legislation over a Senate filibuster, for example.

“We are fully prepared to say there is a better way to solve this problem than force people to buy insurance they don’t need or don’t want,” he said Thursday.

Advocates of the president’s health care law — and some health care experts who have analyzed the Republicans’ proposal — say the emerging plans would simply put the health care system back to where it was before the law, with too many people uninsured and too many sick people driving up costs.
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“Republicans are saying we have to do something, at least to get us through the next election,” said Uwe Reinhardt, a health care economist at Princeton University who is critical of the Republican approach. But by eliminating the requirements for businesses to offer insurance and for most people to have insurance, he added, “we could go into a death spiral in the individual insurance market because healthy people won’t buy it.”

Republicans say they are ready for that argument. They hope to keep health care a front-burner issue — and turn the 2016 election into a choice between Mr. Obama’s health care program and a detailed, conservative alternative.

“There’s an untapped discussion out there,” said Douglas Holtz-Eakin, a former Congressional Budget Office director who has advised Republican presidential candidates. “It’s coming.”

For Republicans itching for that fight now, a Supreme Court decision for the plaintiffs in King v. Burwell, the latest challenge to the health law, would force the issue.

Mr. Obama’s first recourse would be to rush to Congress with a quick technical fix that would eliminate the words in the law that are in dispute.

If Congress resists, predicted Mr. Sasse, the Nebraska senator, the administration would probably appeal to the 37 governors and legislatures that have declined to build their own state exchanges, offering ways to put the exchanges in their states into compliance with the court’s decision.

Under the Ryan-Upton-Kline proposal, states would be able to opt out of the health law’s individual and employer coverage mandates, and insurance policies would no longer have to meet the minimum coverage standards. But it would maintain generous tax credits for the purchase of private insurance policies.

The trio would keep the health law’s most popular elements: allowing children to stay on their parents’ policies until age 26, prohibiting lifetime coverage limits and protecting people with existing health problems.

In the Senate, Mr. Hatch and Senator Richard Burr, Republican of North Carolina, are pushing an even broader plan to replace the health law.

Their Patient Choice, Affordability, Responsibility and Empowerment (CARE) Act would offer tax subsidies for the purchase of health care to any family earning up to 300 percent of the poverty level and replace the Obama health care tax on expensive “Cadillac” health plans with a limit on the deductibility of employer-provided health insurance.

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