Republicans left with few options after ruling

WASHINGTON — Congressional Republicans acknowledged their options are limited in replacing the Affordable Care Act though they vowed that the U.S. Supreme Court decision upholding federal subsidies is not the end of their fight.

“You deal with the rules that you have,” said House Budget Chairman Tom Price of Georgia. “And now, the rules won’t let you do everything you wanted to do.”

Republican presidential candidates, some of who serve in Congress, added their voices to calls to scrap the law, though they didn’t say how they’d do so.

The court in a 6-3 ruling Thursday upheld the law’s nationwide tax credits used by millions of Americans to buy insurance. The court said the Affordable Care Act, also known as Obamacare, allows tax credits in all 50 states, not just the 16 that have authorized online insurance exchanges.

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It’s unclear whether Republicans will attempt to use a budget maneuver known as reconciliation, an option they have endorsed in the past, to quickly move changes to the law through Congress. House Speaker John Boehner said that no decision has been made on whether to use that procedure.

Boehner said the Republican “struggle” against the health care law will continue. Yet he would not commit to any vote this year to replace the law, the use of reconciliation, or even suggest how broadly the Republican effort to change the law might be.

“My point is there’s been no decision,” he said in a news conference Thursday after the court ruling.

Price, an orthopedic surgeon before being elected to Congress, said the House Republican conference will probably decide to use reconciliation to try to repeal the health insurance law. “I think that’s where the conference will be,” he said.

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Rep. Paul Ryan, chairman of the House Ways and Means Committee, had been working on a contingency plan in case the court ruled against the law. He said after the decision was announced that his committee “will continue its work to advance a patient-centered alternative to finally repeal and replace Obamacare.”

Senate Majority Leader Mitch McConnell, a Kentucky Republican, urged Democrats to work with Republicans to alter the law — which he called “a rolling disaster” — to mitigate what some Republicans say are adverse impacts on the American public.

“The politicians who forced Obamacare on the American people now have a choice: crow about Obamacare’s latest wobble towards the edge, or work with us to address the ongoing negative impact of a 2,000-page law,” McConnell said in a speech on the Senate floor shortly after the ruling was issued.

McConnell has in the past raised the possibility that Republicans could use reconciliation to undo the law. His spokesman Don Stewart didn’t immediately comment on whether McConnell would pursue that approach now. The Senate Appropriations Committee Thursday approved a spending bill that would block the Department of Health and Human Services from spending funds to implement the law.

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Reconciliation is a procedural shortcut that would limit the opposition congressional Democrats could wage. It allows legislation to advance through the Senate with 51 votes, instead of 60.

But attacking all of the health-care law’s regulations and parts through reconciliation would be complex. President Barack Obama said at the White House Thursday that the Affordable Care Act “is here to stay” and is providing health care to millions of Americans.

“What we’re not going to do is unravel what has been woven into the fabric of America,” the president said. “I can work with Republicans and Democrats to move forward. Let’s join together. Make health care in America even better.”

Democrats in Congress said the court’s ruling is a signal to Republicans to stop trying to change the law.

“Stop wasting the time of the American people by trying to repeal a law,” said Senate Minority Leader Harry Reid, a Nevada Democrat. “Enough’s enough. Let’s move on.”

Some Republicans insisted that legislative repeal is the next step, with a number of potential ways to pursue it.

Rep. Matt Salmon of Arizona predicted that repeal will now become a common theme of Republican candidates. Several Republicans, including presidential candidate Sen. Marco Rubio of Florida and Rep. Pete Sessions of Texas, have bills ready or are working on bills to modify or replace the law.

“I remain committed to repealing this bad law and replacing it with my consumer centered plan that puts patients and families back in control of their health care decisions. We need consumer care, not Obamacare,” Rubio said.

Sessions told reporters he would have a bill ready within days “that talks about the vision that Republicans could have.” He added, “we’ve got lots of members of Congress and it will be one of the options.”

Rick Santorum, a former U.S. senator from Pennsylvania, was among the 2016 White House contenders calling to change the law, although he offered few details.

“Today’s ruling by the Supreme Court is yet another reminder that if we are to rid our nation of Obamacare once and for all, we need to elected a conservative president prepared to lead on day one,” Santorum said. “As president, I will be committed to repealing the monstrosity of Obamacare and replacing it with a patient-centered program that puts people first, not the government.”

— Erik Wasson contributed from Washington.