Six years after losing the battle in Congress over the Affordable Care Act, Republicans haven't stopped fighting to reverse the results. They've had little or no luck on Capitol Hill, even though they now control both the House and the Senate. On Thursday, however, they won a skirmish in court when a federal judge canceled funding for the subsidies that help millions of poor people pay the out-of-pocket costs of doctor visits, outpatient care and hospitalizations. The GOP win, if upheld, is a loss for many of their constituents.
At issue are roughly $4 billion in annual "cost-sharing" subsidies for households at or near the poverty line who obtain discounted insurance policies through Obamacare. On Thursday, U.S. District Judge Rosemary M. Collyer held that the administration did, in fact, spend money that Congress chose not to appropriate, usurping Congress' constitutional power of the purse. She also put her order on hold to give the administration the chance to appeal.
The ruling, if upheld, would give insurers two options. They could continue to provide the cost-sharing subsidies as required by the law, passing along the multibillion-dollar expense to all their Obamacare customers through higher premiums. Those with higher incomes would have to absorb the increase, while those with lower incomes would receive bigger premium subsidies — at taxpayer expense. Alternatively, insurers could argue that they were free to drop the subsidies if the government didn't pay the reimbursements required by the 2010 law (a requirement that may also give them grounds to sue). That would put healthcare out of reach for many of those newly insured by Obamacare.
Either way, an enormous number of people could suffer. But that seems to be the GOP's strategy in its scorched-earth approach to Obamacare: Rather than trying to fix the possible statutory defects and make the law work better, they've sought to destabilize it, causing enough pain and turmoil that Democrats abandon it. Yes, the law has problems, particularly when it comes to reining in the cost of coverage and care. But one key to slowing healthcare costs is making care more efficient and effective, a task that's impossible to do when a large swath of the population is uninsured.
It's unfortunate that a federal judge should inject the courts into the political fight over Obamacare, rather than letting lawmakers settle it themselves. The issue here isn't Congress' power of the purse so much as its ability to renege on a legal commitment to insurers and their customers without a vote. Republicans don't like the commitments Congress made in 2010, but they shouldn't be able to walk away from them while they're still the law.