By Bill Kaplan
No GOP members of Congress voted for the Affordable Care Act (ACA), despite its being based on the following conservative principles once supported by leading congressional Republicans and GOP presidential candidate Mitt Romney:
* Health care exchanges selling private insurance, with competition between insurers controlling costs and maximizing choice;
* Federal tax-credit subsidies for the middle and working class to buy affordable quality health insurance;
* Mandate for most to have health insurance (similar to state laws requiring auto insurance).
Although the Supreme Court upheld the constitutionality of the ACA in 2012 and 10 GOP govs. expanded Medicaid, many conservatives still want to kill the ACA:
* 56 votes in the GOP-led House to weaken or repeal the ACA;
* GOP congressional lawsuit against President Obama over implementation of the ACA and calling for blocking federal payments to insurers that lower out- of-pocket health insurance costs for the working poor.
The latest effort by conservatives is another Supreme Court case challenging the ACA - King v. Burwell - brought by the Competitive Enterprise Institute (partly funded by the Koch brothers). Wisconsin GOP Rep. Paul Ryan filed an amicus brief in support of the lawsuit which seeks to kill the ACA by striking down federal tax-credit subsidies (remember these tax credits make health insurance affordable) in states like Wisconsin that don't have a state exchange (Gov. Scott Walker refused to establish) and use the federal exchange (at issue is some sloppy legislative wording).
Rep. Ryan attended the Supreme Court hearing last week. He also co-authored an op-ed for the Wall Street Journal, once again promising a GOP alternative to the ACA, all the while doing everything he can to kill the ACA. And, Gov. Walker acts like he has no responsibility: Walker turned down federal funding for a Wisconsin exchange, asked the Supreme Court to strike down the ACA in 2012 and opposed Medicaid expansion. Moreover, the Walker administration cut thousands from Medicaid, directing those individuals instead to purchase health insurance on the federal exchange. It was a wily maneuver, but now haunts Walker. Why?
King v. Burwell is a shot across the bow at the 205,839 Wisconsinites (90 percent getting federal tax-credit subsidies) who have bought affordable quality insurance on the federal exchange. If the Supreme Court rules that the tax-credit subsidies are available only on state exchanges, millions will lose their health insurance, including the 183,000 Wisconsinites that get federal tax-credit subsidies. Moreover, health insurance premiums will skyrocket because healthier people will not buy health insurance without federal aid and hospitals and doctors may have to dismiss employees because of more uncompensated care. Walker disingenuously says it's not his fault: "That responsibility doesn't fall in the hands of the states or the governors, it falls in the hands of the leaders right here in Washington." As for Ryan's empty promises, the Wall Street Journal said: "Congressional Republicans say they won't move to preserve consumers' health insurance tax credits if the Supreme Court strikes them down, raising the stakes in the latest legal challenge to the Affordable Care Act".
-- Kaplan wrote a guest column from Washington, D.C. for the Wisconsin State Journal from 1995 - 2009