WASHINGTON -- Republicans in the House and Senate discussed proposals Wednesday to temporarily help millions of people who could lose federal health care subsidies if the Supreme Court overturns the aid.
In addition, the proposals would dissolve many of the mandates of President Barack Obama's health care law, including that most people buy coverage and most companies provide it to their workers, Republicans said.
"First of all, we're taking care of people who are going to get hurt," said Rep. Charles Boustany, R-La. "Secondly, we're creating a bridge to help the states deal with the fiasco."
The details emerged as Republicans on both sides of the Capitol met privately to discuss how to respond to the court ruling, which is expected in the next two weeks. The decision could result in nearly 7 million people losing subsidies to buy coverage under the Patient Protection and Affordable Care Act.
Lawmakers and aides said the plans were not final and could change.
Under the plan presented by four committee chairmen to House Republicans and described by several legislators, aid would continue for the rest of 2015 if the court voided the subsidies.
After that, states could abandon all of the health care law's rules, including its abolition of lifetime coverage limits and its requirement that family policies cover children until age 26. States doing that would receive federal block grants they could use to continue providing subsidies for people buying insurance. States would be able to structure the aid however they chose.
The block grants would last for two years. After that, the Affordable Care Act would be eliminated altogether -- leaving it up to the new president and Congress to craft a new approach.
If a state turned down the block grant, individuals could receive tax subsidies directly as they do now.
Senate Republicans are discussing a similar structure, though fewer details were available. Senators said their plan would temporarily provide aid to people losing subsidies -- perhaps as block grants to states -- and would abolish the mandates for individual and employer-provided coverage.
A leading author of the evolving Senate approach, Sen. John Barrasso, R-Wyo., said it would help people now receiving subsidies through the 2016 elections.
"We need to fix health care in America, but Obamacare cannot be fixed," Barrasso said.
"This is not a long-term solution," Barrasso said. "We want to provide a temporary transition while this is re-litigated in the 2016 elections -- and give the new president time to come in and bring a new solution forward."
The Senate's second-ranking Republican, John Cornyn of Texas, said he would support continuing the subsidies to make sure that insurance coverage doesn't lapse for people who could be affected by a ruling.
"That's, as far as I am concerned, the No. 1 consideration, is to make sure that people aren't hurt any more by Obamacare," Cornyn said after a meeting Wednesday. "We don't know what the Supreme Court's going to do, but we want to be ready."
The GOP's approach carries political risks, including whether it can unite behind an approach and push it through Congress. Some conservatives have already expressed opposition to extending the law's subsidies if the court strikes them down.
"I do not believe we should extend subsidies. I think the proper answer is to allow states to opt out" of the law's requirements, said Sen. Ted Cruz, R-Texas, a candidate for his party's presidential nomination.
South Carolina Sen. Lindsey Graham, another Republican presidential contender, said most Republicans -- himself included -- support some sort of subsidy extension.
Rep. Dennis Ross, R-Fla., said House GOP leaders argued that the situation presents an opportunity for Republicans.
"This is transitioning out of Obamacare, not repealing it and not even affirming it. It's transitioning," Ross said. "I think at the end of the day when we realize that we have one opportunity to respond and that Congress will be the focus of that response, we have to be together and do that, I think that that may carry the day. It's going to take a lot of coalescing."
Sen. Bill Cassidy, R-La., who last week introduced a bill that would provide money to help people buy insurance with much less federal regulation, said: "Doing nothing is not an option. We cannot sit idly by as millions of Americans lose their health insurance."
The lawsuit's issues
The lawsuit before the Supreme Court was brought by conservatives and backed by the GOP. They say that under the law, the aid is limited to states operating their own insurance marketplaces and is not allowed for states that rely on the federal exchange.
Democrats say the overall bill's context makes clear that the subsidies were designed to go to residents of every state.
In the 34 states most likely to be hit hardest if justices void the subsidies, about 6.4 million people receive the aid, averaging $272 monthly, according to the Health and Human Services Department. Analysts have warned that most of those people would no longer be able to afford health coverage if the assistance ended.
Obama's press secretary, Josh Earnest, said that if the Supreme Court ruled against the administration, it would throw the health care system "into utter chaos." Given that Democrats are likely to oppose Republican proposals, he said, "It's hard to imagine any sort of legislative fix passing."
The Affordable Care Act prohibits insurers from denying coverage because of a person's illness or disability. Given this provision, insurers said, the individual mandate and subsidies are needed as an incentive for healthy people to sign up. Their premiums help pay for the care of less healthy subscribers.
A study by the American Academy of Actuaries offered a dire forecast of what could happen if the subsidies were voided.
"A temporary extension of premium subsidies would only delay the market disruption," it said. "An immediate or near-term elimination of federal premium subsidies would cause massive disruption in the individual market. Potentially millions of people would drop coverage, and the average costs of those remaining insured would soar."
If the Obama administration loses in the Supreme Court, federal health officials could try to blunt the effect by making it easier for states to establish exchanges, thus preserving subsidies for their residents.
But Republicans could stymie White House efforts to work around a court decision. It is unclear whether Republican governors would want to establish exchanges, and opponents of the Affordable Care Act could file lawsuits challenging any move by the administration that deviates from the letter of the law or regulations specifying how a state exchange is to be established.
Sen. Ben Sasse, R-Neb., has introduced a bill to prevent "bureaucratic workarounds." It says the federal government cannot enter into a new contract with a state to make available the technology used in healthcare.gov. The bill would provide financial assistance, in the form of tax credits, for up to 18 months of transitional coverage, but the aid would be gradually reduced and eventually eliminated.
"Republicans must not extend or renew Obamacare but instead offer temporary, transitional assistance completely outside of Obamacare's structure," Sasse said.
Information for this article was contributed by Alan Fram, Erica Werner and David Espo of The Associated Press; by Kathleen Hunter and Billy House of Bloomberg News; and by Robert Pear of The New York Times.
A Section on 06/18/2015