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Affordable Care Act To Face Critical Test At Supreme Court


There has been no piece of legislation more divisive than the Affordable Care Act. Tomorrow, the ACA faces another critical test when the Supreme Court hears arguments in King V. Burwell. That issue is whether Congress intended for the federal health insurance exchange to offer the same subsidies as the state exchanges. NPR national political correspondent Mara Liasson considers the politics at stake.

MARA LIASSON, BYLINE: Since the ACA was enacted, it's been consistently unpopular. But with enrollment surging, there are now 11 million people signed up. It's also become a part of many Americans' lives. And that's helped drain some of the passion from the debate, says Kaiser Family Foundation President Drew Altman.

DREW ALTMAN: It wasn't a big issue in the midterms, and now the King case has come along, which I guess you could view as the last gasp of the opposition to derail the law. It's also a fork in the road.

LIASSON: If the Supreme Court rules for the government, the ACA will continue to chug along. But, says Drew Altman...

ALTMAN: If the plaintiffs win, there'll be chaos in the marketplaces. And it's likely to become a superheated political issue again.

LIASSON: Chaos because as many as 8 million people in the 34 states that chose not to set up their own exchanges could lose their subsidies and their health coverage if the court rules against the government. The administration insists there's no way to fix this. The president's senior adviser, Dan Pfeiffer, says there is no plan B.


DAN PFEIFFER: Our plan is to prevail in the courts. We feel very good about our case. We feel we're very strong in the law. And we look forward to having the Department of Justice make the case for the Supreme Court.

LIASSON: In addition to chaos in the marketplace, Drew Altman thinks a ruling for the plaintiffs in King V. Burwell would scramble the politics of health care. Now it would be Democrats pointing to people who've lost their insurance just before giving birth or having chemotherapy.

ALTMAN: It would flip the politics of the ACA. The Democrats have long been on the defensive, but with millions of people losing coverage, they would likely then go on the offensive.

LIASSON: A ruling against the government would be a mortal blow to the health care law and many Republicans would say good riddance, happy to sit back and watch the whole edifice of Obamacare collapse in a heap. Kim Strassel, a member of the editorial board of The Wall Street Journal, says that would be a big mistake.

KIM STRASSEL: Many Republicans and conservatives want to do that because they think that it would be good for there to be some havoc out there. That Americans would rise up even more than they have and demand an end to the law. And I think that that's probably very wishful thinking, and, in fact, they could do a lot more damage to themselves with that strategy.

LIASSON: Because all of a sudden Republicans could be held responsible for the health care horror stories. That's why other Republicans, including Senate Majority Leader Mitch McConnell - speaking here to The Wall Street Journal - see an opening for Republicans to switch their tactics, finally, from repeal to replace if the court rules against the government.


SENATOR MITCH MCCONNELL: If that were to be the case, I would assume that you could have a mulligan here, a major do-over of the whole thing.

LIASSON: A group of Republican lawmakers in the House and Senate are crafting what they call an off ramp from Obamacare - legislation that would temporarily restore the lost subsidies and then replace them with other forms of financial aid, like tax credits. They'd also do away with the law's minimum coverage requirements and the individual mandate. But no one is betting that Republicans can come together on a rewrite of the health care law because they've been trying and failing to do that for six years - Kim Strassel.

STRASSEL: That's the risk for Republicans. This court case ought to be a spur to them to finally unify around something. If they handle this badly and they look un-unified, they could very easily help cement Obamacare for the future.

LIASSON: Because, Strassel says, without a major fix by Congress, governors and states that didn't set up exchanges would be under pressure to do so in order to prevent hundreds of thousands of their citizens from losing coverage. Then there's the president. If the court rules against him, would Mr. Obama be willing to accept changes in the law? Dan Pfeiffer, who points to polls that consistently show majorities opposing repeal, offers a qualified yes.


PFEIFFER: What you usually see is people who say keep it, but improve it, which is the president's message. And if Republicans are willing to drop the sort of repeal at all costs attitude and work with the president on ways in which we can make the law work better, he'd be happy to do that.

LIASSON: If the Supreme Court rules against the administration, the president would be under enormous pressure to salvage what he could of his signature legislative achievement. But that depends on Republicans agreeing on a plan and then both sides being willing to compromise - very big ifs indeed. Mara Liasson, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

Mara Liasson is a national political correspondent for NPR. Her reports can be heard regularly on NPR's award-winning newsmagazine programs Morning Edition and All Things Considered. Liasson provides extensive coverage of politics and policy from Washington, DC — focusing on the White House and Congress — and also reports on political trends beyond the Beltway.