Milbank: With this Congress, alternative to Obamacare is nothing

With that tone set, the rank and file followed. “Why does the administration choose to trample on the Constitution?” Rep. Charles Boustany, R-La., wanted to know.

Rep. Jim McDermott, D-Wash., proclaimed that states such as Alabama and Georgia “clearly don’t care about the level of health care,” which prompted Rep. Tom Price, a Georgia Republican, to interrupt with a request that McDermott “take back the disparagement of the citizens of Georgia.”

Rep. Sam Johnson, R-Texas, couldn’t even bring himself to utter the usual pleasantries to the witness, Health and Human Services Secretary Sylvia Mathews Burwell. “I guess I’m supposed to thank you for being here, but I have to tell you I’m not in agreement with much of what you’re saying,” he announced.

If the playground taunts achieved anything, it was to demonstrate why the stakes are so high in the looming King v. Burwell decision. If the Supreme Court does invalidate key parts of Obamacare, it seems unlikely that this fiercely divided Congress will come up with anything to replace the law. The alternative to Obamacare is nothing.

Merits of the law

A few Republican members tried to argue with Burwell about the merits of the law, but this did not prove to be a fruitful pursuit for them. “It looks like to me everything’s going up,” Johnson said, complaining about health care costs. Burwell pointed out that Medicare spending was $300 billion below forecast and that per-capita health care cost growth has been the lowest in 40 years. “Well, but the insurance rates are going up,” Johnson pressed. Burwell said rates are going up at a lower rate than before enactment.

Few in the room put their best feet forward. Ryan informed Burwell that “the administration has kind of been a little two-sided” and asked whether Obama would have a “my way or the highway” approach in the future. “Talk about two-sidedness,” Levin replied, adding that “my way or the highway” is “precisely what has been your approach.” The Democrat added, “All you’ve done is issue op-eds.”

“And bills,” Ryan said, interrupting. “And bills — contrary, contradictory bills,” Levin continued. “So you don’t have any plan, like you haven’t had a plan for 60 years.”

The 45-year-old Ryan smirked, grinned and rolled his eyes as Levin spoke, and he hectored the 83-year-old Democrat, who didn’t conceal his disgust with the chairman. And these guys, if the Supreme Court strikes down Obamacare, would have to write a new health care law together? That would be quite a feat.