It will be up to state officials and Congress to help consumers who can't afford health insurance if the Supreme Court strikes down health law subsidies for millions of Americans, Health Secretary Sylvia Burwell said.
"The critical decisions will sit with the Congress and states and governors to determine if those subsidies are available," Burwell told the House Ways and Means Committee on Wednesday.
The secretary told Congress earlier this year that the administration has no authority to undo "massive damage" that would come if the court invalidates the subsidies in the online exchanges that the federal government operates in about three dozen states.
The court is expected to issue a ruling in the case, King v. Burwell, by the end of this month. More than 6 million people could lose those payments and many more residents could see their premiums increase because of the havoc the loss of subsidies would cause in the market.
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The challengers argue that one clause in the law says those federal payments would be available to consumers only in states that run their own exchanges. But the administration has argued the legislative intent was to make subsidies available to customers in every state, regardless of how its exchange was established.
During the hearing, Republicans pressed Burwell to indicate what type of legislation President Barack Obama might sign to restore subsidies if the court rules for the challengers. Many Republican lawmakers have acknowledged that they would like to find a way to offer a temporary option to help consumers, but they have failed to coalesce around a specific proposal.
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Burwell said while the administration would be open to considering alternatives that make health care more affordable and accessible, the president would not sign legislation from Republican Senator Ron Johnson of Wisconsin. That bill would maintain the subsidies for current beneficiaries through August 2017 but repeal the health law's requirements that most individuals get coverage, that larger businesses offer insurance to their workers or pay a penalty and that plans provide specific types of benefits.
"Something that repeals the Affordable Care Act is not something the president will sign," Burwell said.
A recent report from the American Academy of Actuaries said some changes favored by Johnson and other Republicans, such as eliminating the individual mandate, "could threaten the viability" of the health insurance market for individual plans.
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Echoing comments she made last week, Burwell said the administration will work with states to help mitigate the consequences for consumers if the Supreme Court ruled against federal subsidies.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
