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Republicans May Opt to Reinstate Parts of Obamacare if Invalidated by Supreme Court

Republicans think they’ve figured out a way to clean up after the ruling on the Affordable Care Act from the Supreme Court. They have articulated a series of options after the fact to retain some elements of the law, the parts they view as the most popular.

If the law is upheld, Republicans will take to the floor to tear out its most controversial pieces, such as the individual mandate and requirements that employers provide insurance or face fines.

If the law is partially or fully overturned they’ll draw up bills to keep the popular, consumer-friendly portions in place — like allowing adult children to remain on parents’ health care plans until age 26, and forcing insurance companies to provide coverage for people with pre-existing conditions. Ripping these provisions from law is too politically risky, Republicans say.

If you continue to provide coverage for people with pre-existing conditions without a mandate, you create a problem for insurance companies that I assume they will solve by jacking up prices as much as humanly possible to stay profitable. That’s a recipe to break the market entirely. There are certainly ways to move forward without a mandate, but just eliminating the pre-existing condition exclusion with no other constraints on insurance company activity doesn’t qualify. And the insurance industry certainly believes that the market reforms only work without a mandate. That pressure may be enough for Republicans to back off, and bear the burden for returning the nation to the broken status quo on health care.

Perhaps as a compromise, Republicans will keep the high-risk pools in place now for patients with a pre-existing condition. The problem is that these have performed miserably thus far.

House Speaker John Boehner plans to move ahead in stages with smaller bills throughout the summer that would reinstate parts of a law Republicans have demonized since day one. And some conservative Republicans know that and would continue to object to these measures. “I don’t want any vestige of Obamacare left in law,” said Rep. Steve King (R-IA).

If we want to talk about a plan on health care that could move things forward a bit, we could start with Lamar Alexander’s idea to federalize Medicaid in a swap with moving education to the states. That’s certainly a better idea than what Boehner has in mind. But a landscape where the Supreme Court overturns part or all of the law is really uncharted territory, and I don’t think anyone has gamed out a legitimate way forward at this point.

UPDATE: And now Speaker Boehner had to backpedal by saying “Our plan remains to repeal the law in its entirety. Anything short of that is unacceptable.” The conservatives have him on a mighty short leash, don’t they?

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David Dayen

David Dayen