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 The influence of elections in 2016 as well as restrictions already
put in place in states opposed to President Barack Obama's health
law could hamper even a short-term compromise, experts said during a
panel discussion in Boston at The Forum at Harvard T.H. Chan School
of Public Health, presented in collaboration with Reuters.
Their views run counter to the optimism expressed by many Obamacare
watchers, from Wall Street investors to healthcare executives, who
are betting either Congress, the White House or individual states
could come up with a fix to keep the subsidies flowing to nearly 6.4
million people.
Without subsidies, millions of people could drop their insurance
plans and prices of other individual plans could then rise, pushing
millions more Americans out of the market. People unable to afford
insurance could be exempt from the law's mandate to have insurance,
undermining a key component of the healthcare reform law.
 The Supreme Court is expected to rule on the case, known as King v
Burwell, in the next two weeks. The challenge, brought by
libertarian opponents of Obamacare, argues that the law only allows
subsidies in states that have set up their own exchanges to sell
health insurance, rather than rely on the federal HealthCare.gov
website.
If the court decision requires the government to stop paying these
subsidies, Republicans may offer some sort of legislation to
reinstate them, but are likely to require other concessions that
Democrats, including Obama, would refuse to consider. They might
include throwing out the law's individual mandate that requires most
Americans buy health insurance or pay a fine.
"The Republicans will send something to the president who will
reject it," Douglas Holtz-Eakin, president of the conservative
American Action Forum, said during the discussion. "There will be a
period of stand-off."
Harvard professor Robert Blendon compared the potential wrangling in
the aftermath of a Supreme Court decision to unsuccessful efforts to
broker even an interim agreement between warring factions in the
Middle East process.
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"The dilemma is that both parties are going to think it's smart not
to reach an agreement," Blendon said. "What's too bad is that we
actually could reach a compromise through the (2016) election, and
that's what people who care about this should be working on."
The White House has said there is no "Plan B" to continue subsidies
should the court invalidate them, and that it is up to the states
and Congress to find a fix.
But many of the states using HealthCare.gov decided against setting
up an Obamacare exchange because their Republican leaders oppose the
law. Some have sought its repeal.
There is a "distinct lack of political will" to embrace any part of
Obamacare in states like Texas, which are also home to the largest
numbers of uninsured people in need of subsidies, Harvard professor
John McDonough said.
A decision against the government would likely come up in the 2016
elections. "A lot of people will be voting on this issue," McDonough
said.
A replay of the discussion is available at
http://theforum.sph.harvard.edu/events/americas-healthcare-future/.
(Reporting by Sharon Begley, Caroline Humer and Andrew M. Seaman;
Editing by Tom Brown)
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