Clinton, Bush on how they'd handle health care ruling

Hillary Clinton and Jeb Bush had very different answers when asked the best course of action if the U.S. Supreme Court strikes down out the federal subsidies for some 6 million people who buy health insurance under the Affordable Care Act.

But both presidential candidates, in interviews with The Des Moines Register last week, talked about extending insurance coverage and making changes to the federal law often referred to as Obamacare.

Clinton, a Democrat, said she wants to wait to see what the court says first, so she declined to "answer the hypothetical" about the right course of action.

But she will defend the law, and will be prepared to set forth proposals after the court ruling on how to fix various problems, she told the Register in a sit-down interview at the Iowa State Fairgrounds after her first big Iowa rally June 14.

Bush, a Republican, supports repealing the law.

But if the court rejects the subsidies for people in 37 states, including Iowa, one possibility is to extend coverage while Republicans debate alternatives – "and I would have one of those," Bush told the Register in an interview before his first big Iowa rally June 17 in Pella.

Conservatives who brought the King v. Burwell lawsuit say the Obama administration is breaking the law by providing federal subsidies to consumers in states that haven't set up insurance exchanges "established by the state."

More than 30 states haven't done so, and instead rely on the federal market at healthcare.gov. In Iowa, nearly 40,000 people receive subsidies, averaging about $260 per month.

The Obama administration argues that the law was meant to provide federal subsidies to consumers in all states. The Supreme Court is expected to decide by the end of June.

Here is what Clinton, a former U.S. secretary of state and former New York U.S. senator, and Bush, a former Florida governor and former real estate developer, had to say in their own words:

DES MOINES REGISTER: What would be the best course of action if the U.S. Supreme Court decision on the Affordable Care Act wipes out the federal subsidies for the states that didn't do their own health care exchanges? Do you have a proposal to fix that? What would be the best way to get it through the Republican-controlled Congress?

HILLARY CLINTON: "First of all, I'm not going to answer the hypothetical, because it's important that we wait to see what the Supreme Court does.

"I am hopeful that the Supreme Court will understand that the case being presented to them does not merit the end of the subsidies for so many millions of Americans who now for the first time are able to get and keep health care.

"I have said I will defend the Affordable Care Act, so no matter which way the Supreme Court decides, I will be prepared to set forth what I would do.

"If the Supreme Court does what I believe it should do, based on the law and based on the facts, that would mean that it would not rule in favor of the very contorted argument that is being made by the opponents to blow up the Affordable Care Act's guarantee of coverage.

"There will however be change, fixes, that I would like to see in the Affordable Care Act going forward and I will be laying those out.

"So if the court does what I hope and believe it should do, I will still have proposals over the course of the campaign – about how to fix the family glitch, for example. About how to deal with the high cost of deductibles that put such a burden on so many working families, and how to deal with the exploding cost of drugs, particularly the so-called specialty drugs.

"So I will be prepared to put forth my proposals about maintaining the quality affordable health care system that we finally in our country are beginning to build."

DES MOINES REGISTER: What do you think is the best course of action if the Supreme Court strikes down federal health care subsidies in 34 states leaving millions without health insurance? I asked Hillary Clinton what she'd do for a fix and she said she's not going to answer a hypothetical.

JEB BUSH: "I think the Republicans at a minimum need to use this as an opportunity to get behind a bill that's submitted to the president's desk, so as to let him decide if he wants to engage with Republicans and fix Obamacare or set the stage for its outright repeal.

"And Republicans generally know that we want to repeal it. The House has voted with pretty consistent regularity for outright repeal, and I support that. But we need to also focused on what we're for.

"In the Burwell case, assume it was ruled unconstitutional, one of the possibilities would be to extend it for a period of time so as to get beyond the election and allow the election to be a place where people offer alternatives. And I would have one of those.

"And also, do more than that: to use great labs of democracy – our states. Give them the flexibility to come up with alternatives to this very static top down driven bureaucratic heavily regulatory laden confusing law, so that could play out in different ways.

"In Florida, it might be we for the people who are lower and middle income maybe we would give them the option, for the people that are going to lose their insurance in the current system – Florida will have more people lose insurance if this Burwell decision happens because we have a federal exchange not a state exchange. More than Texas. Because they were more effective in signing people up.

"You could offer a no employer mandate, no employee mandate fewer mandated benefits, low deductible, lower premium, catastrophic coverage.

"The exchanges themselves aren't – actually that's a Republican idea. They were first conceived as an alternative to Hillarycare. The Heritage Foundation proposed this. Those exchanges could be used if they weren't as coercive to be able to get scale for people to get lower cost. Have insurance be portable. Give broad discretion to states to create exchanges that would look more like a Republican vision of how you expand access to health care insurance.

"The president's likely to veto that. You don't know until you get it there, though.

"But at least we would be for something that we could then go make our case to the American people on.

"Look, it's not a hypothetical. How's that a hypothetical? Court's going to rule on it in two weeks. She's doing the rope a dope on you."