Paul Ryan: “This is the beginning of the end of the Affordable Care Act.”

June 23rd, 2015

Paul Ryan offers these remarks about King v. Burwell:

“This is the beginning of the end of the Affordable Care Act,” Representative Paul Ryan of Wisconsin, the chairman of the House Ways and Means Committee, said in an interview.

Mr. Ryan said Republicans were preparing legislation that would protect policy holders from losing subsidies until 2017, when Mr. Obama would no longer be in office. At that point, Mr. Ryan said, Republican lawmakers would try to work with the new president to fully dismantle the health care law and replace it with a more conservative approach.

“The key is to get into 2017,’’ Mr. Ryan said. “That’s why the court ruling is so devastating to him. It will expose this law, and make it certain that Congress will be rewriting this law fully once he’s gone.”

But Mr. Ryan, who vowed to unwind the Affordable Care Act when he was a vice-presidential candidate in 2012, predicted that the court would rule against the law.

“I think they cut corners trying to get this bill into law,’’ Mr. Ryan said. “Those chickens are coming home to roost.” If the court rules against Mr. Obama, he added, “I think it’s a huge blow to his efforts to create a legacy.”

Tom Daschle (remember him–he had to withdraw from being HHS Secretary so we got Kathleen Sebelius instead) offers the counter-point:

“It would be a huge, devastating blow to the country,” said Tom Daschle, a former Democratic senator from South Dakota. “It is cataclysmic, from an insurance perspective.”

Republicans, who control Congress, say they are aware that Americans may look to them for a solution, and could blame them if bickering and gridlock get in the way. But many say they are gleeful that the court may do with a single decision what Republican lawmakers could not accomplish in five years: cripple one of Mr. Obama’s signature achievements.

The president’s allies still hold out hope that the court will not undermine the president’s health care law, noting that even some Republicans believe that Congress intended to allow the subsidies when it passed the legislation. Mr. Daschle said he put the odds of the court’s allowing the subsidies to continue at about 50-50.

Mr. Daschle said Mr. Obama had helped bring about other long-term changes to the country’s health care system that would endure even if the court struck down the subsidies. As an example, he said, hospitals are moving away from the fee-for-service model of payment that has helped drive up the cost of health care.

“There’s an inexorable quality to all of this,” Mr. Daschle said. “With each week, each passing month, each year, it becomes an integral part of the health care system.”

Making the changes part of the fabric of the American health care system was the essence of the White House strategy in 2009 and 2010. Mr. Obama and his top aides, led by Rahm Emanuel, who was the White House chief of staff, pushed Congress to pass a health care overhaul quickly to capitalize on Democratic control of Capitol Hill. They also wanted Mr. Obama to have time to put into action whatever law passed.

Over time, they believed, the changes would burrow their way into public expectations of what government should provide, much like Medicare andSocial Security, and, in the process, become a major influence on the way Mr. Obama is remembered.

“For millions of Americans, the Affordable Care Act is embedded and is a reality,’’ said David Axelrod, who was a senior adviser to Mr. Obama when the health care law was debated in the first term. “That’s not something to be trifled with.”

This is the line the President used in his speech to the Catholic Hospital Association–it is part of the “fabric” of our nation, it is a “reality,” and cannot be unraveled.