GOP lawmakers vow to keep up fight

Boehner: No strategy decision yet

House Speaker John Boehner of Ohio said, “Obamacare is fundamentally broken, increasing health-care costs for millions of Americans. Today’s ruling doesn’t change that fact.”
House Speaker John Boehner of Ohio said, “Obamacare is fundamentally broken, increasing health-care costs for millions of Americans. Today’s ruling doesn’t change that fact.”

WASHINGTON -- Congressional Republicans acknowledged Thursday that their options are limited in replacing the Patient Protection and Affordable Care Act, though they vowed the Supreme Court decision upholding the federal subsidies that are the backbone of the law is not the end of their fight.

photo

AP

White House staff members listen to President Barack Obama’s remarks Thursday after the Supreme Court upheld federal health insurance subsidies under the Affordable Care Act.

"You deal with the rules that you have," House Budget Committee Chairman Tom Price, R-Ga., said. "And now the rules won't let you do everything you wanted to do."

The court in a 6-3 ruling Thursday upheld the nationwide tax credits used by millions of Americans to buy insurance. The court said the Affordable Care Act allows the credits in all 50 states, not just the 16 that have authorized their own online insurance exchanges.

The practical effect of taking government assistance from people who bought their coverage on the federal exchanges could have made the entire law unworkable, because so many consumers would have found their new insurance policies unaffordable, many health care experts said.

House Speaker John Boehner, R-Ohio, said Thursday that the Republican "struggle" against the health care law will continue.

"Obamacare is fundamentally broken, increasing health-care costs for millions of Americans," Boehner said in a statement. "Today's ruling doesn't change that fact."

It's unclear whether Republicans will attempt to use a budget maneuver known as reconciliation, an option they have endorsed in the past, to quickly move changes to the law -- or a repeal -- through Congress. Reconciliation would limit Democrats' ability to block a bill by allowing legislation to advance through the 100-member Senate with 51 votes, instead of 60.

Boehner said no decision has been made on whether to use the procedure, which Democrats used to pass the law when they controlled the Senate.

Senate Majority Leader Mitch McConnell, R-Ky., has in the past raised the possibility that Republicans could use reconciliation to undo the law. His spokesman Don Stewart didn't immediately comment on whether McConnell would pursue that approach now.

Even if the Republican-led House and Senate were able to pass legislation repealing the health care law, Obama has said he would veto it, and Democrats could provide enough votes to sustain a veto. The House already has voted more than 50 times to repeal all or part of the law.

Thursday's court ruling is a "very strong decision," said Joseph Antos, a health-policy expert at the American Enterprise Institute, a group that supports limited government.

"Because this is such a strong decision and endorsement of the Democrats' stand on this, it makes it even less likely that Republicans could pass any kind of legislation changing anything about the Affordable Care Act," Antos said.

Price, an orthopedic surgeon before being elected to Congress, said House Republicans will probably use reconciliation to try to repeal the Affordable Care Act.

"I think that's where the conference will be," he said.

While Republicans publicly spoke out against the Supreme Court decision, some said privately it was a relief.

More than 6 million Americans -- most of them in conservative states -- would have suddenly been without the government subsidies that make health insurance affordable under the act. And it would have primarily been the responsibility of Republicans to come up with a solution that could pass both houses of Congress and be signed into law by Obama, they said.

Former Republican National Committee Chairman Ed Gillespie called it "a bad legal outcome, but a good political outcome" for Republicans. But he added that it will increase pressure on his party to come up with a specific alternative to the law ahead of the 2016 elections.

Pollster David Winston, who advises the GOP congressional leadership, said, "Ultimately, the challenge for Republicans is not just how to deal with this law, but where's the direction? Where are the alternatives?"

Rep. Paul Ryan, R-Wis., chairman of the House Ways and Means Committee, had been working on a plan in case the court ruled against the law. He said after Thursday's decision that his committee "will continue its work to advance a patient-centered alternative to finally repeal and replace Obamacare."

Rep. Matt Salmon of Arizona predicted that repeal will now become a common theme of Republicans. Several including presidential candidate Sen. Marco Rubio of Florida and Rep. Pete Sessions of Texas have bills ready or are working on bills to modify or replace the law.

Sessions said he would have a bill ready within days "that talks about the vision that Republicans could have." He added, "We've got lots of members of Congress and it will be one of the options."

In addition to the push against the law from Republicans in Washington, governors and lawmakers in states that have fought against the Affordable Care Act strengthened their calls to repeal it.

"The Supreme Court abandoned the Constitution to resuscitate a failing health care law," Texas Gov. Greg Abbott, a Republican, said in a statement. "Today's action underscores why it is now more important than ever to ensure we elect a President who will repeal Obamacare and enact real health care reforms."

Texas was among the states relying on the federal health exchange and had no backup plan if the court had struck down the subsidies. Abbott had no interest in setting up a state exchange for the 832,000 Texans relying on the federal tax credits that lowered their monthly premiums.

He and other GOP governors said it would have been up to the president and Congress to fix the law if the subsidies had been struck down.

Florida would have been ground zero for the aftermath, with more than 1.3 million people relying on the federal subsidies. Republican Gov. Rick Scott and House Republicans strongly opposed a state Senate bill that would have created a state-run health exchange as well as expand Medicaid.

Scott reaffirmed his commitment to repealing the law Thursday.

"It's a bad law," Scott said. "It's made promises after promises."

Patients React to Ruling

While Republicans charted a new path toward repealing the law, the court's decision to allow the subsidies to continue was a relief to many who had purchased health insurance policies through the federal exchange.

Among them was Jennifer Greene, a 58-year-old from Boca Raton, Fla., who feared she would have to go without insurance if she lost her $547-a-month tax credit.

She had insurance through her job at a large grocery store chain but lost it because she missed too much work after surgery to remove part of her colon, which required lengthy follow-up care.

Greene signed up for a midlevel insurance plan in February, paying $25 a month after the tax credit. She was able to keep her primary-care doctor and has relied heavily on the insurance to cover follow-up appointments with specialists and a hernia surgery.

"Those things are not affordable without insurance," she said Thursday. "Having the insurance makes the difference of staying healthy or ignoring your health issues."

With the coverage expansion under the law, about 90 percent of Americans now have health care. After the Supreme Court ruling, the focus will shift to those who remain uninsured. But closing the gap will mean persuading some 20 states that have resisted the law's Medicaid expansion to drop their opposition.

Shawn Turner of Cisco, Ill., finished chemotherapy for uterine cancer last summer and relies on the $830-a-month tax credit she and her husband receive for regular follow-up scans to make sure the cancer is gone.

If the court had struck down the subsidies, she said, they would have had to dip into their savings or start selling their possessions to pay for their insurance.

"I'm just so relieved and happy, not just for me but for everyone who's being helped by this," said Turner, 55.

Mary Kitchens, 50, who lives near San Antonio, is paying less than $100 a month for her subsidized coverage. She began crying when informed of the decision.

"I don't even have words," said Kitchens, who was diagnosed with multiple sclerosis in 2009. "It's amazing. It's amazing."

Kitchens, who works in marketing for a real estate firm, is a single mother with four children.

The decision "means that I'll have options" in obtaining medication and treatment, she said. "It means I won't be a burden to my children. Without it, I felt so doomed. ... Without insurance, you succumb to the disease. And I don't want to do that."

With no subsidy, her bill could have jumped to to $600 a month, she said.

Atlanta resident Ted Souris, 62, described himself as an "arch-conservative" who initially opposed the health law. He said he had mixed feelings about the ruling. He receives what he calls "a pretty hefty subsidy" to buy insurance -- he gets $460 and only pays $115 a month for insurance.

"I'm so against Obama, and I hate that he has any kind of victory," Souris said, "but it's nice that I don't have to worry" about affording health coverage.

He said he doesn't like getting what he calls "a government handout" but that the law -- and the subsidy -- allowed him to retire early and still have coverage.

"I am glad I have the Affordable Care Act, and I appreciate that I got the subsidy."

Information for this article was contributed by Billy House, Kathleen Hunter, Erik Wasson, Heidi Przybyla and Kathleen Miller of Bloomberg News; by Karen Tumulty, Ed O'Keefe, Lena H. Sun and Robert Gebelhoff of The Washington Post; and by Kelli Kennedy of The Associated Press.

A Section on 06/26/2015

Upcoming Events