Blunt backs GOP bill to retain health care subsidies should the Supreme Court strike them down

WASHINGTON – Sen. Roy Blunt has signed on to a controversial bill that would at least temporarily preserve a key provision of the Affordable Care Act, a law the Missouri Republican has railed against as an unworkable disaster.

The bill, co-sponsored by Blunt and 30 other Republicans, would allow low-income Americans to keep their Obamacare subsidies until August 2017, if the Supreme Court rules that those federal payments are illegal. The proposal, unveiled last week, would kill other elements of the health reform law, repealing the individual and employer mandates, among other things.

Blunt, R-Mo., said the proposal would free Missourians from the grip of Obamacare, but he sidestepped questions about his support for extending the law's federal subsidies, which come in the form of tax credits based on income.

"I'll keep fighting until we fully repeal and replace this deeply flawed law with common-sense health care solutions," Blunt said in a statement to the News-Leader. If the Supreme Court rules that subsides are illegal, Blunt said, "then this bill would help the millions of Americans who were once again hurt by Obamacare's false promises."

Blunt's support for the proposal illustrates the high-wire walk he and other Republicans face as they await a decision from the high court in the case of King v. Burwell.

In that legal case, conservatives have challenged the legality of the federal subsidies now offered to individuals in the 34 states that did not set up their own exchanges. That includes Missouri, where more than 200,000 residents are receiving federal aid to help cover the cost of health insurance purchased on the federal exchange.

At issue before the Supreme Court is one line in the Affordable Care Act, which says the subsidies can be offered through a health care exchange "established by the state."

Blunt and others argue that "plain text" clearly means that only consumers who buy insurance through a state exchange — not the federal exchange — can receive the subsidies. Supporters of the law say the Affordable Care Act's authors never intended to prevent federal subsidies from flowing through the federal exchange.

If the justices rule that the subsidies are illegal, as Blunt and other Republicans hope, more than 7 million Americans could lose that federal assistance, making their health coverage suddenly unaffordable. There will be intense pressure on the GOP-controlled Congress to prevent those people from losing that financial assistance — and to guard against possible chaos in the insurance marketplace if people suddenly drop their coverage.

At the same time, Blunt and others do not want to be seen as saving Obamacare. Enter the new GOP bill, introduced last week. Blunt has not advertised his support for the proposal, adding his name to it without sending out a press release or mentioning it to reporters during his weekly media call.

Sen. Ron Johnson, R-Wis., the measure's chief sponsor, said it would allow for a smooth transition away from Obamacare.

"This bill is a transitional response that rescues Americans from the coercive nature of Obamacare, which is an unnecessarily complicated scheme that should not be resuscitated," Johnson said in a statement last week.

Although it has gained significant support inside the Senate GOP conference, the bill is already under attack from conservatives who say it's a capitulation.

"For Republicans in Congress to restore subsidies … (if the high court strikes them down) would be a terrible betrayal of their voters and their professed principles," reads a recent editorial in the National Review, an influential conservative publication. "This bill could end up being an opening bid in a negotiation. Already there is some talk of bargaining away" the provisions that kill the Affordable Care Act's mandates.

Joseph Antos, an expert on health policy at the American Enterprise Institute, a centrist think tank, said it's not surprising the measure has sparked ire on the right, where "any suggestion that one more cent would be spent (on Obamacare) is anathema."

Antos said Republicans won't find a warmer reception among Democrats, who will resist anything that unravels central elements of the law, even if it protects the subsidies.

"Obama's immediate response to any Republican push will be 'All you have to do is change four words in the law'," Antos said, referring to the line at issue in the King v. Burwell case. "From a PR standpoint, that is going to have so much resonance."

Already, some Democrats are dismissing the new GOP proposal as more of the same: an effort to essentially gut the Affordable Care Act without offering a real replacement.

"The Republicans in Congress have abdicated the responsibility of devising a replacement if the Supreme Court strikes down the law," said Sen. Claire McCaskill, D-Mo. "I'm hopeful the court makes the right call on a reform that's currently providing private insurance to hundreds of thousands of Missourians."

In the House, Republicans have yet to coalesce around legislation to address possible fallout from the Supreme Court case. Rep. Billy Long, R-Springfield, who sits on a key committee that formulates health policy, declined to weigh in on the Senate proposal.

"He has no interest in commenting on what the Senate is or is not doing," said Long's spokesman, Cole Karr. "Rep. Long continues to work with his colleagues on getting back to patient-centered healthcare reforms. If the court throws out insurance subsidies to certain states, his subcommittee will have an answer to a path forward."

Contact Deirdre Shesgreen at dshesgreen@usatoday.com or follow me on Twitter @dshesgreen