As SCOTUS considers King v Burwell the healthcare insurance industry, and their customers, wonder what will happen if the decision goes for the plaintiffs. In the short-term, it will mean nothing to the citizens of the District of Columbia, and the 14 states that opened exchanges. In the remaining states it is estimated that anywhere from 4M – 10M citizens will lose their subsidies, and all customers would likely see shocking spikes in the their premiums.

Certainly, our leaders have a plan in place to address a “doomsday” ruling, right? Wrong. Typical of the dysfunctional Washington way, the two sides have taken the stubborn position that the responsibility for crafting a solution belongs to the opposition.

Republican Senator John Barrasso sums up his side’s position thusly, “It’s not our responsibility to fix the law that the president signed and [that] was passed on partisan lines.” On the other side, the White House is apparently taking the stand that, “We have a plan. It’s called the ACA. If you break it, then you need to fix it.”

If neither side comes up with a fix, citizens in the 36 affected states would lose their subsides, and see their premiums quadruple. This would result in healthier patients giving up coverage they can’t afford, leaving only the sickest, who can’t afford not to have health insurance, in the system. This would start a “death spiral” in the insurance industry as premiums soar and enrollment free falls.

To be fair, a GOP workgroup has been formed to research alternative actions. Establishment leaders insist that they have a plan that will bridge the loss of subsides with, well subsides either by extending the current system, or in the form of tax rebates. Conservative activists have already voiced their fierce opposition to any plan looks like it supports the ACA in way, shape or form.

At the same time, Republican Governors in the 34 states without exchanges will come under siege from angry constituents who lose their subsidies and coverage. Many, if not all, will likely solve their problems by pushing for the formation of exchanges in their states, thus allowing the subsidies, along with the rest of the ACA, to continue unchanged. This, of course, also would cause conservative opponents of the ACA to go ballistic, and result in many other citizens questioning the wisdom and the purpose of such a massive and expensive exercise in futility.

Hoo boy. Does all of this make your head hurt too?