This is what happens when you let this guy do the thinking for you.
Engage in a bit of pretend for a moment. Pretend we're three or four weeks in the future and pretend that the Supreme Court has ruled in
King v. Burwell that the IRS interpreted Obamacare incorrectly all along, so some 8 million people aren't really supposed to be getting subsidies for insurance. Now pretend like, in the intervening month, Republicans have actually been able to both create and coalesce behind the "plan" they've been tossing around, get it passed in both chambers, and not vetoed by President Obama. Given all that, what would that mean for the law, for all the people directly affected, and for everyone else.
Disaster, says a new issue brief from the American Academy of Actuaries. Greg Sargent reports:
The group looks at both the idea of a temporary continuation of subsidies, and of the repeal of the individual mandate—both of which have been discussed as part of various GOP contingency fix plans, such as the one offered by Tea Party Senator Ron Johnson, which is backed by dozens of GOP Senators, including the leadership.
Doing away with the mandate, the group concludes, would "threaten the viability of the health insurance market." If the GOP alternative also keeps protections against people with preexisting conditions—which Republicans generally favor, perhaps because they're popular—those with "lower cost health care needs" will drop coverage, meaning the average costs of those left behind will be higher. This "could result in adverse selection that would raise premiums."
The group also concludes that "a temporary extension of premium subsidies" might succeed in delaying the disruption of markets. But it notes that if the temporary subsidies are made available only to those who are currently getting them, and not to new enrollees—an idea that has been circulating—that, too, could create problems. It would result in "lower overall enrollment in the individual market, as some individuals would transition out of coverage, but few would transition in," causing the "risk profile of the market to deteriorate somewhat."
Since we're only talking about a temporary extension, because remember Johnson's plan has them only extend until after he's re-elected, it's only delaying the inevitable disaster—millions dropping insurance when they eventually lose their subsides and the scenario in which "premiums will increase substantially, unless other equally strong mechanisms are implemented." Which will drive more people out of the market and inevitably destabilize. This, Larry Levitt of the Kaiser Family Foundation tells Sargent, makes actuaries' heads "explode over the prospect of an insurance market where people with pre-existing conditions are guaranteed coverage but there are no subsidies or an individual mandate." That because when there is no mechanism to compel people to be insured and insurers are required to take all comers—generally the sick people—they would have to rise premiums. That means, Levitt says, "all people buying insurance in the individual market, not just those receiving subsidies under the Affordable Care Act, would pay more." So they're not just wrecking things for Obamacare customers, they're wrecking the whole individual insurance market.
Of course, this isn't the inevitable outcome of a Supreme Court ruling. The court could rule for the administration and we can avoid this whole mess. Alternatively, as Sargent says they have a few options. Republicans could wake up to the destruction they've been egging on and decide to actually participate with congressional Democrats and President Obama to fix it. Since that's never going to happen, if they pass anything it'll be this plan that includes repealing the mandate. They know that's veto-bait and they want that plan vetoed so that they can blame all this on Obama. Or, and this seems likeliest because in five years they haven't been able to coalesce on a plan, they don't pass anything and they try to blame it all on Obama anyway. Because it's always his fault.