The White House is planning to spend $6.4 billion by the end of next year to support Obamacare's state health insurance exchanges. And there's nothing Congress can do to stop it.
President Obama's budget, released Tuesday, shows that the government has already spent almost $4.3 billion on grants to implement state exchanges between 2011 and 2013. About $28 million of this was spent on states that later opted out of building their own exchange, according to a Kaiser Health News analysis.
Unlike the federal exchanges, the administration has unilateral authority to fund the state exchanges. Funding for the federally facilitated marketplaces, on the other hand, is largely at the whims of Congress, where Republicans have taken a hardline against allocating money for the law.
In Democrats' original vision of the Affordable Care Act, states were expected to establish their own exchanges, especially with the added incentive of virtually unlimited federal dollars to do so. As a result, federal dollars were not originally allocated to the implementation of a federally-facilitated marketplace, leaving the feds scrambling last year to piece together money from other parts of the budget.
Currently 16 states plus D.C. are running their own exchanges, while the remainder are participating in the federally run marketplace. Yet only $1.5 billion was spent on implementation of the federal exchange in 2013, compared with over $2.1 billion on state exchanges.
The Centers for Medicare & Medicaid Services is asking Congress for $629 million for marketplace implementation in 2015. The agency plans to collect $1.2 billion in user fees from issuers participating in the federal marketplace that will offset cost, bringing the total program spending to $1.8 billion in 2015.
"If Congress funds the president's budget, this would fully fund the ongoing implementation of the Affordable Care Act, so we hope that they will indeed fund it," Health and Human Services Secretary Kathleen Sebelius said in a press conference Tuesday. "If Congress fails to pass a budget then we will look at varying other sources of funding for the full implementation."
Getting this funding approved is not likely. The administration asked for additional funding for federal implementation from Congress last year, but the request was denied.
According to the latest enrollment numbers, about 1.4 million people have enrolled in coverage on state-based exchanges, compared with 1.9 million on the federal exchange.