Republicans Stretch the Truth on Obamacare Funding

U.S. Rep. Jack Kingston speaks U.S. Rep. Hank Johnson (D-GA) before President Barack Obama speaks to a small crowd at the Savannah Technical College March 2, 2010 in Savannah, Georgia. The President's visit is part of the White House's Main Street Tour where he meets with members of the community to share ideas for rebuilding the economy in an effort to spend some time outside of Washington and talk to American families about what they are experiencing during these tough economic times.
National Journal
Sarah Mimms
Jan. 21, 2014, 2:35 p.m.

When the ap­pro­pri­ations bill passed through Con­gress, Re­pub­lic­ans and Demo­crats both claimed vic­tory on pro­vi­sions re­lated to the Af­ford­able Care Act. Re­pub­lic­ans touted small cuts aimed at the law’s im­ple­ment­a­tion, while Demo­crats crowed that the law’s fund­ing was pro­tec­ted.

A closer ex­am­in­a­tion of the le­gis­la­tion shows a much more nu­anced out­come, in which Re­pub­lic­ans did get some of the cuts they wanted — just not all those they’re tak­ing cred­it for.

There’s ac­tu­ally very little ap­pro­pri­at­ors can do to stall the health care law, said Re­pub­lic­an Rep. Jack King­ston, who heads the House Ap­pro­pri­ations sub­com­mit­tee that deals with the Health and Hu­man Ser­vices De­part­ment.

Most of the fund­ing for the law is man­dat­ory, not dis­cre­tion­ary, leav­ing GOP ap­pro­pri­at­ors with few op­tions when it comes to de­plet­ing the law’s re­sources.

But King­ston said they cut what they could.

“The Obama­care bill when it was passed ac­tu­ally ad­vance-fun­ded its ap­pro­pri­ations and the man­dat­ory doesn’t come un­der our bill,” he said. “Any fund­ing that was channeled in­to im­ple­ment­ing Obama­care, we have cut.”

Demo­crats dis­agree, ar­guing that fund­ing for the law and its im­ple­ment­a­tion is nearly equi­val­ent to what Con­gress au­thor­ized in fisc­al 2013.

What ac­tu­ally happened is that Re­pub­lic­ans have said re­peatedly that the om­ni­bus spend­ing bill cuts $1 bil­lion from the Pre­ven­tion and Pub­lic Health Fund, a pro­gram with­in the Af­ford­able Care Act that is de­signed to provide fund­ing for pre­ven­tion and well­ness ini­ti­at­ives. While the bill provides the full $1 bil­lion re­ques­ted for the PPHF for the cur­rent fisc­al year, it also al­loc­ates those re­sources to spe­cif­ic dis­ease-pre­ven­tion pro­grams, pro­hib­it­ing the Obama ad­min­is­tra­tion from us­ing the fund­ing to off­set the costs of im­ple­ment­ing the health care law.

Wor­ried that HHS Sec­ret­ary Kath­leen Se­beli­us was us­ing it as a “slush fund” to provide ex­tra money to pay for im­ple­ment­a­tion, Re­pub­lic­ans in­cluded a pro­vi­sion that spe­cific­ally al­loc­ates every cent for fisc­al 2014 to a vari­ety of pre­ven­tion and well­ness pro­grams, in­clud­ing dia­betes, heart dis­ease, and can­cer pre­ven­tion pro­grams. The de­part­ment also has to ac­count for every trans­fer.

The move al­lowed law­makers in both parties to de­clare vic­tory.

Sen. Tom Har­kin of Iowa, King­ston’s Demo­crat­ic coun­ter­part on Sen­ate Ap­pro­pri­ations and the au­thor of the PPHF por­tion of the Af­ford­able Care Act, said this marks the first time Con­gress has fully ap­pro­pri­ated re­sources for the fund since the law passed in 2010. The fund was raided in 2012 to pay for the Medi­caid “doc fix” and in 2013 to help pay for en­roll­ment ef­forts un­der the health care law.

“As the au­thor of the fund, I con­sider the al­loc­a­tion of these re­sources to pre­ven­tion and well­ness as a ma­jor achieve­ment in this bill,” Har­kin said on the floor last week. Health care groups were also en­thu­si­ast­ic about the pro­vi­sion.

In terms of oth­er im­ple­ment­a­tion fund­ing, the bill does provide $2.5 bil­lion for “pro­gram op­er­a­tions” at the Cen­ter for Medi­care and Medi­caid Ser­vices, one of the primary ac­counts from which the ad­min­is­tra­tion has drawn im­ple­ment­a­tion funds. King­ston points out that the money is $1.5 bil­lion less than HHS re­ques­ted in the pres­id­ent’s 2014 budget. But the fund­ing for the pro­gram is ac­tu­ally set at ex­actly the same al­loc­a­tion HHS was giv­en in fisc­al 2013.

Still, Re­pub­lic­ans did get one clear vic­tory in work­ing to un­der­mine the Af­ford­able Care Act: The bill cut $10 mil­lion from the In­de­pend­ent Pay­ment Ad­vis­ory Board, a con­tro­ver­sial pro­vi­sion of the law. The board is charged with mak­ing bind­ing re­com­mend­a­tions to Con­gress for re­du­cing Medi­care costs be­gin­ning in fisc­al 2015, but it has been lam­basted by con­ser­vat­ives as a “death pan­el” and a bur­eau­crat­ic ex­er­cise.

Re­pub­lic­ans have touted the IPAB cuts, but Demo­crats have said little about the is­sue.

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