I hope it does not happen. I hope that temptation is avoided, that cooler, saner heads will prevail in the U.S. Supreme Court, and that justices will decide not to gut the core of ObamaCare. (We may get a glimpse of their intentions next week, when the court hears arguments in King v. Burwell).
But if they do decide to seize this opportunity, chaos will reign. More than 7 million Americans -- almost half a million in Georgia alone -- will be stripped of the subsidies that make their health insurance affordable. Those who are healthy would probably decide to drop their coverage; those who are sick and need the insurance would probably keep it if at all possible. That would set off the dreaded "death spiral" in which insurance costs skyrocket for everyone, making it unaffordable for many.
"... insurers would suddenly have a risk pool filled with high-need, high-cost people, after having priced their 2015 premiums based on a balanced pool containing both healthy and sick people. Claims would quickly outpace premium revenue as insurers lose most of their low-cost, healthy customers but retain customers whose medical costs exceed their premiums."
Insurers will withdraw from the market. Even those customers who don't use a subsidy to buy insurance will see the price of coverage soar by almost 50 percent, according to a RAND study. Hospitals and doctors will lose paying customers. It will be a complete and absolute mess, and the job of cleaning it up will fall largely to Republicans who are totally unprepared for that responsibility.
That prospect ought to terrify GOP leadership, and it probably does. They simply have no idea what to do about it.
Let us count the reasons why the GOP will be held responsible for what happens:
1.) In the wake of a Supreme Court ruling gutting ObamaCare, Republicans will party like it's 1999, and understandably so. They will have slain their Moby Dick and they will be dancing around its carcass. However, as they gleefully take credit for bringing the program down, in the eyes of the public they will also be taking responsibility for what happens afterwards. The perception will be that they broke it, they will have to fix it.
2.) In addition, any solution to the post-decision chaos at the federal level will have to come via legislation passed through Congress. Who controls both the House and the Senate? Republicans do, although "control" is not exactly the right word. Congress is so deeply dysfunctional that it can't even perform mundane tasks, let alone craft a complicated, ideologically fraught rescue of one-sixth of the American economy in a matter of weeks or months. With a presidential election looming, the GOP's inability to govern will be put under an extremely harsh spotlight.
3.) Compounding the problem, Republicans have been promising to "repeal and replace" ObamaCare for five years now. The phrase has been repeated so often as to become imprinted on the national memory. However, the general public has no real understanding yet that the "replace" part of that phrase is a total joke. Republican leaders have never done the difficult work of crafting a workable alternative, nor have they spent the time and energy needed to build a consensus within their own highly argumentative party in support of such an alternative.
4.) And who will be most affected by a decision that subsidies can't be paid through federal insurance exchanges? In the largely blue states that have already set up their own state-run exchanges, ObamaCare will go on pretty much as before. People will still get their subsidies; they will get to keep their coverage. The chaos will come in red, Republican-run states such as Georgia that stubbornly refused to take part in the program.
In short, the millions who lose their subsidies and health insurance will tend to be white and they will tend to be Southern. Most will be working people; most will be lower- and middle-class. They will, in short, tend to vote Republican.
And when they turn for help to their state legislators -- remember, the whole problem could be solved almost immediately by setting up a state exchange -- they will be told no. There is no way in hell that Republican state legislators will vote to "save" ObamaCare right after a major Supreme Court decision that guts it. That's sure going to get interesting.
Again, the best course is that none of this happens, that the justices take a somber look at the implications of the case and decide not to push the country 's health-care system into an abyss. But if they do, the Republicans' moment of greatest triumph will quickly become their biggest nightmare.