Ohama World Herald - Sen. Ben Sasse Offers Plan if Obamacare Subsidies are Eliminated

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By Joseph Morton

A court decision eliminating government subsidies in the federally run insurance marketplaces could be a dream come true for conservative opponents of the health care law -- or it could prove a nightmare.

On the surface, eliminating the subsidies would deal a huge blow to the health care law that Republicans have been fighting from the start.

But it also could prompt more states to set up their own marketplaces in order to help residents retain their subsidized coverage, a step that would further cement the law into place.

That prospect has GOP lawmakers talking about the need for some kind of temporary safety net for the millions at risk of losing coverage -- a possible outcome of the case that the U.S. Supreme Court will hear next week and is expected to rule on by June.

The most detailed proposal so far is coming from Sen. Ben Sasse of Nebraska.

"We need to not do anything to resuscitate Obamacare," Sasse said. "And yet we need to provide temporary, transitional assistance to those who are exiting Obamacare so they can do it in an orderly way."

Sasse's outspoken opposition to the health care law was a centerpiece of his campaign and earned him the title "Obamacare's Nebraska Nemesis" from the National Review.

In an interview with The World-Herald on Thursday, Sasse predicted that the court will toss out the subsidies.

"That is good news," he said.

But he said that the administration has set up the rules in such a way that insurers will be able to drop customers in the middle of the year if the high court rules against their subsidies. More than 6 million Americans are at risk of losing their coverage, he said.

Sasse said those people did nothing wrong by signing up for those policies and don't deserve to be left out in the cold. But he also said that Congress should not try expanding, extending or fixing the health care law.

Instead, Sasse said, he plans to introduce legislation next week that would continue providing subsidized coverage for 18 months to those who lose their coverage, in a framework similar to the existing COBRA plans for individuals when they leave a private employer.

He said his proposal will not rely on the health care law's legal foundation, its payment mechanisms or its subsidy formula.

Sasse said his initial plan may not specify how much people could receive in subsidies because he wants others to weigh in. But he said the subsidies ultimately would be comparable to -- or perhaps somewhat less than -- current subsidies.

It's not clear what Sasse's plan might cost taxpayers. Ultimately, he said, his proposal would be less expensive than having states create their own marketplaces and sign people up for new coverage.

Sasse presented his ideas at a GOP Senate lunch on Thursday. He said his colleagues have responded positively to it.

Sen. Deb Fischer, R-Neb., also has talked about the need for Congress to take action if the court strikes down the subsidies.

Fischer noted Thursday that she is part of a working group led by Sen. John Barrasso, R-Wyo., that has been examining the situation. In particular, they are concerned about those who would lose insurance.

"Those people need to have coverage up to a certain point," Fischer said. "We can't just cut them off."

At the crux of the Supreme Court case is language in the health care law saying subsidies will be available through marketplaces established by individual states. Those bringing the lawsuit say the law doesn't allow the subsidies to go to people who get coverage through the federal marketplace, which operates in states like Nebraska that decided against setting up their own marketplaces. The Obama administration says the law always intended to provide the subsidies through both state and federally run marketplaces.

In a letter to one member of Congress this week, Health and Human Services Secretary Sylvia Burwell said a court ruling against the subsidies would have a severe impact, especially on the poor. The text of the letter was reported by numerous news outlets.

"We know of no administrative actions that could, and therefore we have no plans that would, undo the massive damage to our health care system that would be caused by an adverse decision," she wrote in the letter.

In response to World-Herald questions about the Sasse plan, HHS officials said they couldn't evaluate the merits until he introduces actual legislation. But they said the administration remains open to improving the law as long as any changes enhance the affordability, accessibility and quality of health care, and also help the economy.

HHS spokesman Ben Wakana said in a statement that the law has been helping families, businesses and taxpayers.

"In the past year alone about 10 million uninsured Americans finally gained affordable health coverage," Wakana said. "In Nebraska, 74,124 consumers selected a plan or were automatically re-enrolled in quality, affordable coverage through the health insurance marketplace during open enrollment. Tens of millions more are now guaranteed access to expanded coverage free of charge for preventive health services, such as a colonoscopy or flu shot, because of new protections in the law. At the same time, as a nation, we are spending our health dollars more wisely and receiving higher quality of care."

He added that the department is confident its interpretation of the law and its subsidies will prevail.

"The most responsible course of action is to continue to implement the law," he said.

Sasse said Republicans need to be offering broader alternatives to the health care law, besides preparing for the possible elimination of subsidies.

The 2016 presidential election should be a national conversation about the current health care law compared with GOP proposals, he said.

"There should be a bunch of competing Republican ideas, but there needs to be one that all market-oriented, patient-centric people unite around heading into the 2016 presidential," Sasse said.

Sasse outlined a plan of his own in last year's Senate campaign. He said he's not sure yet whether he will introduce his own proposal as legislation or negotiate to sign on with the sponsor of another conservative alternative.

"I am zealously on the side of Republican ideas that would make it more possible for people to buy the insurance policy that they want and keep it over the course of a lifetime," he said.

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