Mary Agnes Carey and Marilyn Werber Serafini join Jackie Judd to talk about the permutations of the impending Supreme Court decision on the constitutionality of the health care law. Carey says much is at stake for all people who touch the health care system while Werber Serafini outlines some of the Republican alternatives to the law.
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Here’s a transcript:
JACKIE JUDD: Good Day. This is Health On The Hill. I’m Jackie Judd.
It’s a time of high anxiety here in Washington with the Supreme Court close to issuing its landmark decision on the constitutionality of the health law. How is each party positioning itself in anticipation of that ruling? Here to answer that, two veteran policy reporters, Mary Agnes Carey and Marilyn Werber Serafini of Kaiser Health News. Welcome to you both.
MARY AGNES CAREY: Thanks.
MARILYN WERBER SERAFINI: Thank you.
JACKIE JUDD: You’ve covered the town for a long time. Give us a sense of this moment.
MARY AGNES CAREY: You mentioned high anxiety. I’d throw in nervous anticipation. So much is riding on this decision for so many people. And for so many industries. In the health care industry, for example, you’ve got the pharmaceutical manufacturers, the hospitals, the physicians to name a few. For consumers, there are 32 million people who could get coverage either through the exchanges created in the health law, or through the Medicaid expansion. And there’s wide political ramifications for both Democrats and Republicans. So this is why this is so heavily anticipated.
JACKIE JUDD: A lot of ramifications heading into the November elections.
MARY AGNES CAREY: Absolutely.
JACKIE JUDD: You’ve been covering the Republicans. Is there a position behind which they have coalesced if the law is upheld, and the second scenario, if some or all of it is struck down?
MARILYN WERBER SERAFINI: Right. Look, if the law is upheld you can expect the House immediately — which is, the House controlled by Republicans — to come up with a vote to repeal the law. They’ve done this before. It would likely pass but it wouldn’t go any further than that with a Democratic in the White House and a Democratic-controlled Senate. On the other hand, if the Supreme Court strikes down the law or even individual mandate, Republicans will certainly be rubbing it in from here until November. All eyes are on the November election and the Republicans will want to say “I told you so” all the way from here to then. Look, the message that’s worked very well for them up until now has been “Repeal Obamacare.” It’s gone over well with their conservative base. It’s gone over well with some swing voters and they will certainly keep at it. There’s no chance that they’re going to come back with a massive replacement bill.
JACKIE JUDD: The approach would be more piecemeal. Post-November, what’s on their laundry list?
MARILYN WERBER SERAFINI: There are a number of items. Mitt Romney mentioned one of them last week. He said he would want to give people the opportunity to buy insurance with some kind of subsidy. This is different than the current law which is requiring most people to buy insurance. But the Republicans who have moved more toward encouraging people to buy insurance and reducing the cost. So, other items that have been in the Republican playbook for many years: allow people to buy insurance across state lines, allow small businesses to pool together to purchase insurance, possibly at a lower cost because they’re grouping together, fix the malpractice system, and maybe block-grant Medicaid to the states. So these are all items that are out there and they’ve been there a long time. We can expect it to be a smaller scale approach.
JACKIE JUDD: Moving on to the Democrats, the administration has steadfastly said “we’re confident this law is going to be upheld,” but interestingly of late, administration allies are beginning — in public — to talk about the what-ifs.
MARY AGNES CAREY: There is concern that the Supreme Court could move to strike out the individual mandate and this is the requirement as Marilyn was talking about. It’s in the law that most individuals by 2014 have to purchase coverage or pay a fine. If that were to go away, what advocates of the law are saying is, the mandate is not the heart of the bill — the rest of the health law is not dead. The subsidies would remain, the exchanges would remain, the Medicaid expansion, all these provisions that are in place that people seem to like, keeping an adult child up to the age of 26 on your health insurance policy, or no lifetime limits on coverage — all those things are still there. That is the message their getting ready for in case the mandate is struck.
JACKIE JUDD: One of the great guessing games in Washington at the moment is “Is there a Plan B tucked away in someone’s office at the White House or at HHS? Do you have any sense of there has to be a contingency plan, that just makes sense — any more information?
MARY AGNES CAREY: I’d love to get that document — if anyone listening to this or watching, please I’m waiting for your call at Kaiser Health News. While I don’t have the paper on that yet, I think it’s fair to say that they must be looking — the administration officials must be looking — at alternative measures. For example, if the mandate were taken out of the law, you could put a late enrollment penalty into the health law. In the sense, if you wait to a certain point to get insurance, it’s going to cost you more. That could be a disincentive for people to wait. They’ve got to come up with other scenarios. But I think their absolutely looking at all options and they’ve got to have some things in place, ready to go, if the decision is not to their liking.
JACKIE JUDD: OK, thank you, we should know more in the coming days. Thank you both.