Congressional Republicans face a health care conundrum

Whenever a major reform initiative becomes law, minor tweaks and technical fixes are simply unavoidable. Within a couple of years of Social Security passing, Congress had opened the law back up, identified changes that needed to be made, and made adjustments accordingly. The same is true of Medicare. Washington has worked this way for generations.

And it would be true of the Affordable Care Act, too, if Congress was still able to function. Democrats and Republicans have identified some areas of the law that need tweaking in order to help various constituencies and make the law more effective, but therein lies the rub: GOP lawmakers have decided that “Obamacare” cannot be touched in any way. Indeed, the more policymakers identify the need for adjustments, the more Republicans resist.

It’s not because GOP officials love the law the way it is; it’s because GOP officials desperately hope to sabotage the law and ensure its failure. If Democrats identify worthwhile tweaks, and those changes aren’t made, Republicans are delighted — it means a less-effective law. If some groups are unnecessarily punished, under the GOP’s approach, that’s just too bad.

But what if Republicans actually like some of the groups facing undue punishment, and can prevent the trouble by approving technical fixes? As it turns out, Ann Kim and Ed Kilgore have uncovered just such a conundrum.

For the first time, a constituency group to whom the GOP normally pays close attention — religious institutions — is asking for a legislative “fix” of the Affordable Care Act to make it work as intended. […]

Months of outreach to Republican Senate offices by religious leaders have yielded no official GOP support to an appeal from a broad coalition of religious denominations to ensure that church-sponsored health plans can participate in the ACA’s health insurance exchanges. […]

Without the requested “fix,” as many as one million clergy members and church employees now enrolled in church-sponsored health plans could soon face the choice of leaving these plans (designed to meet their unique needs, such as the frequent reassignment of clergy across state lines) or losing access to the tax subsidies provided by the ACA to help lower-to-middle income Americans purchase insurance.

Under sane political circumstances, this is exactly the sort of thing Congress would fix without any real fuss. But these are clearly not sane political circumstances.

When policymakers wrote the Affordable Care Act, they couldn’t prepare for every contingency, and in this case, there was an oversight — church health plans were not included as part of the eligibility for ACA exchanges. It was the result of a mistake, not malice.

And now, two Democrats — Sens. Mark Pryor of Arkansas and Chris Coons of Delaware — hope to correct that mistake. Ordinarily, this is exactly the sort of thing that would be approved by unanimous consent. After all, who wants to fight to ensure that church health plans aren’t included in exchanges? It’s a no-brainer — without a technical fix, most employees of the nation’s houses of worship will be able to receive subsidies to gain coverage, but they’ll have to choose from plans available through an exchange, which in this case, would exclude their own employer’s plan.

How much would it cost to make the adjustment? Nothing. All Congress has to do is alter the eligibility language in the law. Plenty of politically conservative religious groups, including the Southern Baptist Convention, support the fix.

And yet, it may not happen. Republicans want to destroy health care reform, not improve it, and have vowed to oppose any and all fixes to the Affordable Care Act.

Will GOP lawmakers maintain this posture, deliberately thwarting the needs of religious groups, just out of petty, partisan spite? I honestly don’t know, but I’ll look forward to finding out.