The U.S. Supreme Court is expected to issue a ruling before the end of the month in King v. Burwell, the case that could determine the fate of President Obama’s landmark healthcare law. If the court hands a victory to Republicans by ending subsidies for 6.4 million Americans, Republicans in Congress will be left scrambling to come up with a new game plan. But a win for the plaintiffs will also have a major impact on the 2016 race, leaving the candidates, most of whom have been unable to propose credible alternatives, figuring out how to contain the fallout.
If lawmakers do nothing in the event of a Supreme Court ruling striking down federal health insurance exchanges in more than 30 states, the ACA would be effectively gutted — premiums would skyrocket and leave enrollees unable to afford the costs. As a result, Republicans have offered up a number of fixes, many of which include extending subsidies and killing the individual mandate. But most of the solutions would leave Americans with high premiums and effectively revert to the ineffective system that existed before the legislation was passed.
Here are the alternatives, or lack thereof, that many of the presidential candidates and likely contenders have offered in advance of the Supreme Court’s ruling:
Jeb Bush: The former Florida governor has said the ACA is a “monstrosity,” “flawed to the core” and “the greatest job suppressor in the so-called recovery,” despite the high rate of job growth in the country in recent years. In 2013, he told ABC “I think the best way to repeal Obamacare is to have an alternative; we never hear the alternative.” But other than claiming that Apple Watch could replace the legislation, he has only called for a “market-oriented” alternative, the details of which he has not yet provided. Recently, he has said he supports creating catastrophic coverage to provide relief for families who experience hardship, but those plans do not cover routine illnesses or doctor’s appointments. When Obamacare took effect, Florida had the second highest uninsured rate in the country, and Bush has yet to prove how he would help those in his home state who lose their subsidies.
Ted Cruz: The Texas senator has been one of the most outspoken opponents of Obama’s health care law, repeating in almost every public appearance that he promises to “repeal every single word” of the law. Distinguishing himself from other candidates, he has actually offered up legislation to replace the law — the Health Care Choices Act. His legislation would allow people to buy health insurance across state lines and would undo much of Obama’s law, including the mandate, the marketplaces and the subsidies. But while Cruz has argued that Americans need an alternative that would lower costs, opening insurance markets across state lines could actually lead to higher premiums, among other issues.
Scott Walker: Although he still has not declared his candidacy, the Wisconsin governor and likely contender has joined the Republican chorus in opposing Obamacare, even as he encouraged Republicans to look to the organization that originated the key tenets of the law for alternatives. But his state is one with the most to lose if the law is struck down — Wisconsin opted not to set up its own exchange, so 185,000 people in the state face losing their subsidies that make insurance affordable. Under Walker, 83,000 people were also taken off Wisconsin’s Medicaid program and told to look to the federal exchange, so Walker would be left to deal with those “transitioners” as well. But instead of offering up his own alternative, Walker has said he will leave it to Washington to come up with a fix.
Chris Christie: The New Jersey governor is in a similar position to Walker. Christie opted not to set up an exchange in his state, so more than 172,000 New Jersey residents would lose their subsidies. But while he has said that “Obamacare is a failure, it’s always been a failure and it will not succeed,” he has also been unable to propose an alternative. While the high court’s decision is imminent, Christie recently said he needs more time to think on the issue. “I will have more to say on Obamacare in the weeks and months ahead,” he said in an April speech, adding that he’ll address it in the same “direct and specific way” he discusses Social Security and Medicaid.
Rand Paul: When asked in January on Fox News about his proposal if Obamacare is repealed, the Kentucky senator said “We could try freedom for a while. We had it for a long time… It works everywhere else.” But there are a number of problems with treating health care as a commodity and not a social good, including that it would leave the most vulnerable Americans unable to afford coverage and would require insurers to cover a pool of sick people. When pressed in the interview to explain why he’d want to revert to the old American system in which many more people were uninsured, Paul suggested that there is always charity.
Marco Rubio: Like Cruz, the Florida senator has proposed a plan to take the place of Obamacare. Rubio’s alternative would provide insurance to those who would lose their subsidies in the event of a Supreme Court victory for Republicans. People would be provided refundable tax credits to buy insurance to solve the short-term dilemma of millions of people living without insurance. “A plan such as this will restore our people’s access to quality care,” Rubio wrote in a Fox News op-ed, adding that his plan would also include high-risk pools that would be subsidized by the government. His plan has been strongly opposed by Democrats, partly because he has not detailed how the tax credits would be structured and uniform credits would reduce subsidies for low-income Americans.
Ben Carson: The former neurosurgeon penned an op-ed in 2013 in which he called for health savings accounts to replace the health care law. “Even if the federal government provided such an account for every American citizen that was increased by $2,000 each year, it would cost less than $700 billion a year and everyone would be covered,” he wrote. In reality, though, health savings accounts are likely to increase the number of uninsured and increase health care costs while costing taxpayers billions of dollars.
John Kasich: The Ohio governor, like Christie and Walker, also has a lot to lose in the event of an Obamacare Supreme Court loss because Ohio did not set up its own exchange, so 161,000 residents would lose their subsidies. While Kasich was one of the first Republican governors to embrace Obamacare’s Medicaid expansion, he still wants to repeal the parts of the law he doesn’t like, a position that has led many to call him a hypocrite.
Bobby Jindal: Louisiana also failed to set up an exchange and is facing an impending healthcare disaster. As many as 250,000 Louisianans could lose their coverage, but Jindal has maintained that “When the subsidies go away, the individual mandate goes away, the employer mandate goes away. That’s a great thing. That’s a tax cut.” Jindal’s plan would involve throwing out the health care law entirely and eliminating the individual mandate while starting a $100 billion federal grant to states to subsidize premiums for low-income people. Democrats have said his plan, like other Republicans’, would result in millions of Americans being uninsured.