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The One Phrase That Could Wreck Obamacare

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WASHINGTON – The fate of Obamacare is hanging on a Supreme Court ruling that could come out any moment now. King vs. Burwell is about one little phrase, but it's a hugely important one.

The Affordable Care Act stated people could get subsidies when they signed up with health exchanges established at the state level - or as the law says "established by the state."

Obamacare architects such as Jonathan Gruber said these subsidies or tax credits were part of the pressure the federal government put on the states to form these exchanges.

"If you're a state and you don't set up an exchange, that means your citizens don't get their tax credits," Gruber said at a 2012 presentation.

But most states didn't create exchanges like Democrats in Congress who shaped Obamacare thought they would. They didn't want to.

"They were looking to see a way of kind of keeping more of Obamacare out of their state," Heritage Foundation healthcare policy analyst Nina Owcharenko explained.

"In addition, many of the states chose not to set up an exchange because it's going to be a real cost to the state," he said.

Consequently, millions of Americans signed up on the federal exchange instead and the IRS decided millions of them could get subsidies. Now the Supreme Court justices are deciding if the word "federal" can be used interchangeably with the word "state."

Health and Human Services Secretary Sylvia Burwell told a congressional hearing last week that the high court's ruling will then let Americans know "…whether or not those subsidies can be given in states that have a federal marketplace versus a state marketplace."

Senate Homeland Security & Governmental Affairs Committee Chairman Ron Johnson, R-Wis., warned if the Supreme Court says no, then "millions of Americans who are getting their Obamacare plans through a federal exchange will no longer be eligible for the subsidies."

"That's going to create a lot of chaos, a lot of turmoil in the people's lives," he said.

Tinker or Toss It Out

To prevent that chaos and save those subsidies should the Supreme Court rule against Obamacare, then Congress – now controlled by Republicans like Johnson - must fix the language of the law to say "established by the state or federal government."

But a ruling against Obamacare also gives Republican lawmakers a chance to instead really tinker with or toss out a massive federal program many loath.

One of those loathers is House Ways and Means Committee Chairman Rep. Paul Ryan, R-Wis.

"Obamacare is just flat-busted," he told HHS Secretary Burwell at that same hearing. "We're not talking about a ding or a dent or a fender-bender or a flat tire. The whole law is a lemon."

President Barack Obama suggests this urge to trash or tinker with Obamacare is the same as plotting to steal away health care or subsidies.

"It seems so cynical to want to take away coverage from millions of people, to take care away from people who need it the most, to punish millions with higher cost of care and unravel what's now been woven into the fabric of America," he said in a news conference last week.

Finding the Sweet Spot
 
But there are congressional Republicans offering rescue plans that don't take away coverage in case of an anti-Burwell ruling by the Supreme Court.

For instance, Sen. Johnson's proposal would allow everyone to keep the plans they now have and preserve most of the status quo until August 2017.

"That allows the American people to be involved in deciding the direction of our healthcare system in the 2016 election," Johnson explained to CBN News.

The most vocal anti-Obamacare Republicans grouse that's too easy on Obamacare.

Meanwhile, the administration is upset that Johnson's plan would kill the individual mandate, that penalty that forces almost all Americans to pay into the system, even if they don't have healthcare coverage.

Johnson laughed off the critics of his proposal, saying, "It's being attacked on both the right and the left, which I think pretty well proves that I've found that sweet spot of a very reasonable, very fair proposal."
 
This Supreme Court case has been just one more bad news or bad publicity moment for Obamacare.

At the beginning, there was former House Speaker Nancy Pelosi's famous phrase, "We have to pass the bill so that you can find what is in it."

"The Lie of the Year"

Obama asserted time and again, "If you like your health care, you will be able to keep your health care" and "If you like your doctor, you will be able to keep your doctor."

PolitiFact labeled that "the lie of the year" as millions of Americans learned to their distress they wouldn't be allowed to keep healthcare plans they liked.

First, there was the disastrous rollout of the federal website Healthcare.gov.

Then another PR disaster hit when the public discovered Obamacare architect Jonathan Gruber had said, "Call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass."

Now there's the sad realization hitting many Americans that the assurance Obamacare would drastically cut the costs of their healthcare just isn't true. In fact, many are seeing their premiums go up all over the country.

Opposition Outweighs Support

"We know why there's still more people opposed to the health care law than support it," Owcharenko said. "It's because their prices are going up on their healthcare. And they're not really seeing this great benefit that this administration is trying to showcase."

Johnson added, "Obamacare has dramatically driven up the cost of healthcare. It did not protect patients. It didn't control the cost of healthcare either."

Now comes a Supreme Court ruling that could throw the very shape, even existence of Obamacare, back into open battle in Washington.

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About The Author

Paul
Strand

As senior correspondent in CBN's Washington bureau, Paul Strand has covered a variety of political and social issues, with an emphasis on defense, justice, and Congress. Strand began his tenure at CBN News in 1985 as an evening assignment editor in Washington, D.C. After a year, he worked with CBN Radio News for three years, returning to the television newsroom to accept a position as editor in 1990. After five years in Virginia Beach, Strand moved back to the nation's capital, where he has been a correspondent since 1995. Before joining CBN News, Strand served as the newspaper editor for