By Lesley Weidenbener
Lesley Weidenbener, executive editor, TheStatehouseFile.com
INDIANAPOLIS – Republicans in Indiana and across the nation have a big choice to make: Continue their call to repeal the Affordable Care Act or find a way to work with and improve the existing law.
And their decision will impact key races in 2016.
The U.S. Supreme Court last week upheld the insurance subsidies that are the backbone of the law – called Obamacare by both sides of the issue.
There remain some legal challenges to the act, which aims to get nearly every American insured in part by penalizing people who don’t buy coverage and some employers that don’t provide it. But the courts have generally settled the key issues, which means the law will remain in place unless Republicans can muster enough election victories to get rid of it.
And that seems to be what most Republican want to do – or at least what they say they want to do.
Here’s just a sampling of what some Republicans said in reaction to the court’s decision:
Sen. Dan Coats, R-Indiana: “It is now clear that it will take a new occupant of the White House to repeal and replace Obamacare.”
Indiana Gov. Mike Pence: “ObamaCare must be repealed and states must be given the flexibility to craft market-based solutions focused on lowering the cost of health care rather than growing the size of government.”
Republican presidential hopeful Jeb Bush: “We need a president who will repeal and replace ObamaCare with a conservative solution.”
Republican presidential candidate Rick Santorum: “Today’s Supreme Court ruling is another reminder that if we want to get rid of Obamacare, we must elect a conservative president.”
The problem for repeal advocates is that the Affordable Care Act is already woven into the nation’s health care system. Millions of Americans have bought insurance through a network of exchanges set up by the law and the vast majority are doing so with the help of the law’s subsidies.
And the “conservative solution” that Bush referred to just doesn’t really exist. Republicans have floated bits and pieces of their own ideas – essentially endorsing the parts of Obamacare that everyone loves while promising to eliminate those that are less popular, without ever saying how they’d make or pay for the changes.
Meanwhile, 30 states have made more residents eligible for Medicaid – or Medicaid-funded programs – under an expansion in the health care law. Indiana is one of them, although Pence would never call what he’s done a Medicaid expansion.
Instead, Pence is using the additional Medicaid funding for a program called HIP 2.0, a newer version of the Healthy Indiana Plan that requires participants to pay premiums on a sliding scale based on income. Thousands of Hoosiers have signed up for HIP 2.0 – people who would not be eligible if not for the Affordable Care Act.
Pence boasted about the program on Your World with Neil Cavuto.
“The way we do that, the way – we’re frankly on the leading edge of this in Medicaid reform here in Indiana, as you know – is through consumer-driven health care,” he said on the FoxNews show. “Empower individuals with market-based solutions, consumer choice, patient-centered health care. State based reform, state based innovation, is a key to restoring the full prosperity of this nation.”
But what Pence and other GOP leaders never mention is that HIP 2.0 and programs like it are built on the funding provided by the Affordable Care Act. Repealing the law repeals the funding which would essentially repeal the HIP 2.0 expansion.
And that’s just one of the many issues leaders would have to deal with if they opted to eliminate the Affordable Care Act now. To convince voters that’s a good idea, Republicans need more than just promises of repeal. They need to explain what they’d do in the alternative – and why that would be better.
Lesley Weidenbener is executive editor of TheStatehouseFile.com, a new website powered by Franklin College journalism students.