The Obamacare Funding Farce

Sorry, Ted Cruz. Obamacare needs less money from Congress now that insurers are helping to finance it.

National Journal
Sam Baker
March 4, 2014, 4:50 p.m.

Pres­id­ent Obama is ask­ing Con­gress for more money to im­ple­ment Obama­care. Surely he knows Re­pub­lic­ans won’t give it to him. And Re­pub­lic­ans — just as surely — know that Obama­care will be im­ple­men­ted any­way, be­cause the law con­tains ways for the ad­min­is­tra­tion to fund it with or without Con­gress’s help.

And around and around we go in the flat circle that is Obama­care polit­ics.

It’s all a bit of polit­ic­al theat­er, but it has con­sequences on the ground: The phony fight over “de­fund­ing” the Af­ford­able Care Act drove the gov­ern­ment to shut down this fall — even though the vast ma­jor­ity of fund­ing for the law was nev­er at stake.

Tues­day, it began again, when the White House’s newly re­leased budget pro­pos­al re­ques­ted about $630 mil­lion to sup­port fed­er­ally run in­sur­ance ex­changes — the center­piece of the ACA.

The ad­min­is­tra­tion re­ques­ted al­most twice that amount last year, and the pro­pos­al was so thor­oughly dead on ar­rival that Sen­ate Demo­crats didn’t even try to pass the ex­tra fund­ing. They settled for beat­ing back the equally fu­tile ef­fort led by Sen. Ted Cruz to “de­fund” the law. And after the shut­down was over and the his­tri­on­ics were fin­ished, the status quo re­mained largely in­tact.

This year prom­ises to be little dif­fer­ent.

So, the White House won’t get the $630 mil­lion it says it needs. And it could use the money: Be­cause the ACA didn’t provide any dir­ect fund­ing for fed­er­ally run in­sur­ance ex­changes, the Health and Hu­man Ser­vices De­part­ment has had to cobble to­geth­er as much as it could, through a pro­cess that’s ba­sic­ally the fed­er­al gov­ern­ment’s ver­sion of rum­ma­ging through the couch cush­ions for loose change.

But the ad­min­is­tra­tion has con­sist­ently found ways to work around con­gres­sion­al Re­pub­lic­ans. Con­sider the latest re­quest for ad­di­tion­al fund­ing: HHS is ask­ing for $630 mil­lion, after seek­ing $1.5 bil­lion last year. Why the drop?

It’s be­cause the ad­min­is­tra­tion is now col­lect­ing user fees from the in­sur­ance com­pan­ies that sell plans through Obama­care’s ex­changes. Those fees will bring in around $1.2 bil­lion next year, ac­cord­ing to HHS’s budget doc­u­ments.

The de­part­ment ad­ded those rev­en­ues in with its re­quest from Con­gress, cre­at­ing a total fund­ing short­fall that’s ac­tu­ally a little bit big­ger than last year’s. But now in­surers are provid­ing the ad­di­tion­al fund­ing that Con­gress won’t.

And like so much of the law’s fund­ing, it doesn’t re­quire con­gres­sion­al ap­prov­al. Short of re­peal­ing Obama­care, which is just as un­real­ist­ic as fund­ing it, there’s not much Re­pub­lic­ans can do to cut off these rev­en­ues.

This is why the gov­ern­ment shut­down was so di­vis­ive even among Re­pub­lic­ans. Shut­ting down the fed­er­al gov­ern­ment did very little to stop the flow of money to im­ple­ment the ACA, be­cause most of Obama­care’s fund­ing was provided in Obama­care it­self — not through the reg­u­lar ap­pro­pri­ations pro­cess.

HHS has had to get cre­at­ive to find money for the ex­changes. It tapped pots of money from oth­er parts of the law, some­times an­ger­ing Demo­crat­ic al­lies. It drew down a $1 bil­lion fund for gen­er­al im­ple­ment­a­tion work, and also tapped the law’s pre­ven­tion and pub­lic health fund. Re­pub­lic­ans did suc­cess­fully cut that fund by $1 bil­lion in the spend­ing bill that re­opened the gov­ern­ment, pre­vent­ing HHS from us­ing it again to stand up the ex­changes.

Some of the tricks and back doors HHS used to find ex­tra cash are now ex­hausted or close to it, but in­surers’ user fees are pick­ing up most of the dif­fer­ence.

The de­part­ment de­cided in 2012 that in­sur­ance plans would pay a fee of 3.5 per­cent of their premi­ums to help the fed­er­ally run ex­changes func­tion. (States that run their own mar­ket­places can set their own fees, or choose not to charge one.) Rev­en­ue from the fees will go up along with en­roll­ment.

What We're Following See More »
STAFF PICKS
When It Comes to Mining Asteroids, Technology Is Only the First Problem
2 days ago
WHY WE CARE

Foreign Policy takes a look at the future of mining the estimated "100,000 near-Earth objects—including asteroids and comets—in the neighborhood of our planet. Some of these NEOs, as they’re called, are small. Others are substantial and potentially packed full of water and various important minerals, such as nickel, cobalt, and iron. One day, advocates believe, those objects will be tapped by variations on the equipment used in the coal mines of Kentucky or in the diamond mines of Africa. And for immense gain: According to industry experts, the contents of a single asteroid could be worth trillions of dollars." But the technology to get us there is only the first step. Experts say "a multinational body might emerge" to manage rights to NEOs, as well as a body of law, including an international court.

Source:
STAFF PICKS
Obama Reflects on His Economic Record
2 days ago
WHY WE CARE

Not to be outdone by Jeffrey Goldberg's recent piece in The Atlantic about President Obama's foreign policy, the New York Times Magazine checks in with a longread on the president's economic legacy. In it, Obama is cognizant that the economic reality--73 straight months of growth--isn't matched by public perceptions. Some of that, he says, is due to a constant drumbeat from the right that "that denies any progress." But he also accepts some blame himself. “I mean, the truth of the matter is that if we had been able to more effectively communicate all the steps we had taken to the swing voter,” he said, “then we might have maintained a majority in the House or the Senate.”

Source:
STAFF PICKS
Reagan Families, Allies Lash Out at Will Ferrell
2 days ago
WHY WE CARE

Ronald Reagan's children and political allies took to the media and Twitter this week to chide funnyman Will Ferrell for his plans to play a dementia-addled Reagan in his second term in a new comedy entitled Reagan. In an open letter, Reagan's daughter Patti Davis tells Ferrell, who's also a producer on the movie, “Perhaps for your comedy you would like to visit some dementia facilities. I have—I didn’t find anything comedic there, and my hope would be that if you’re a decent human being, you wouldn’t either.” Michael Reagan, the president's son, tweeted, "What an Outrag....Alzheimers is not joke...It kills..You should be ashamed all of you." And former Rep. Joe Walsh called it an example of "Hollywood taking a shot at conservatives again."

Source:
PEAK CONFIDENCE
Clinton No Longer Running Primary Ads
2 days ago
WHY WE CARE

In a sign that she’s ready to put a longer-than-ex­pec­ted primary battle be­hind her, former Sec­ret­ary of State Hil­lary Clin­ton (D) is no longer go­ing on the air in up­com­ing primary states. “Team Clin­ton hasn’t spent a single cent in … Cali­for­nia, In­di­ana, Ken­tucky, Ore­gon and West Vir­gin­ia, while” Sen. Bernie Sanders’ (I-VT) “cam­paign has spent a little more than $1 mil­lion in those same states.” Meanwhile, Sen. Jeff Merkley (D-OR), Sanders’ "lone back­er in the Sen­ate, said the can­did­ate should end his pres­id­en­tial cam­paign if he’s los­ing to Hil­lary Clin­ton after the primary sea­son con­cludes in June, break­ing sharply with the can­did­ate who is vow­ing to take his in­sur­gent bid to the party con­ven­tion in Phil­adelphia.”

Source:
CITIZENS UNITED PT. 2?
Movie Based on ‘Clinton Cash’ to Debut at Cannes
2 days ago
WHY WE CARE

The team behind the bestselling "Clinton Cash"—author Peter Schweizer and Breitbart's Stephen Bannon—is turning the book into a movie that will have its U.S. premiere just before the Democratic National Convention this summer. The film will get its global debut "next month in Cannes, France, during the Cannes Film Festival. (The movie is not a part of the festival, but will be shown at a screening arranged for distributors)." Bloomberg has a trailer up, pointing out that it's "less Ken Burns than Jerry Bruckheimer, featuring blood-drenched money, radical madrassas, and ominous footage of the Clintons."

Source:
×