Health-care chaos could be coming, with no preparation

In a legal brief filed last year, Georgia Attorney General Sam Olens asked the U.S. Supreme Court to strip some 450,000 fellow Georgians of the federal subsidies that have helped them to obtain health insurance. Most are lower-income working people, some with pre-existing conditions that once made it impossible to get coverage.

What happens if the Supreme Court grants Olens’ request, beyond that fact that hundreds of thousands of now-insured Georgians will lose coverage? Nobody knows, but worse, nobody seems to care.

Certainly, Georgia’s uninsured rate — already the third highest in the country, according to Gallup — would rise still further. The state’s already faltering health-care system would also face additional financial strain, perhaps forcing the closure of more hospitals. (In a performance ranking by the Commonwealth Fund, Georgia’s health-care system was rated 45th in the country in 2014, a rapid decline from 35th just five years earlier.).

But that’s just the beginning. Most experts warn that if Olens and his allies win their argument, the market for individual health coverage in Georgia and other affected states would collapse into chaos. America’s Health Insurance Plans, the nation’s largest health-insurance trade group, warns it would create “severely dysfunctional insurance markets” in Georgia and 33 other affected states, with “a more unstable market and far higher costs than if the Affordable Care Act had not been enacted.”

In a statement last week, Olens said he agreed that “affordable health insurance and excellent care are absolutely needed.” However, he and five other state attorneys general — all Republicans — argue that an estimated five million Americans are receiving subsidies that are illegal under the Affordable Care Act.

“I will not stand by and let this lawlessness go unchallenged, and I cannot apologize for insisting that the president should follow the law,” Olens said.

As Olens reads the law, Obamacare subsidies can be offered only in those states that have established their own health-insurance exchanges. Georgia has refused to establish such an exchange; therefore, health-insurance subsidies are illegal in Georgia.

The legal virtues of the case, King v. Burwell, are hotly contested, with well-respected lawyers offering arguments on both sides. It will probably be decided by yet another 5-4 vote, with arguments in March and a decision expected by June. That’s not much time.

Yet at both the federal and state levels, those pushing the case hardest are doing almost nothing to deal with the chaos that it will produce. They voice confidence that subsidies will be overturned, yet they show little concern about dealing with its aftermath.

Here in Georgia, for example, the state Legislature could fix the problem quickly by voting to establish a state-based insurance exchange, as other states have done. But that won’t happen. To the contrary, last year it voted to bar state employees from preparing for such a step.

And in Washington, where Republicans control both houses of Congress, no visible progress is being made in preparing options. The GOP can’t bring itself to fix Obamacare, nor can it agree even with itself about an alternative. They are eager to destroy, but they appear to have no idea how to build.