The Obamacare Money Congress Can’t Touch

Funding for the federal marketplace is limited, while states running their own exchanges have more access to government dollars.

US Health and Human Services Secretary Kathleen Sebelius testifies before the Senate Finance Committee on health insurance exchanges on November 6, 2013 in the Dirksen Senate Office on Capitol Hill in Washington, DC. AFP PHOTO/Mandel NGAN 
National Journal
Sophie Novack
March 4, 2014, 10:31 a.m.

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.

What We're Following See More »
STAFF PICKS
What the Current Crop of Candidates Could Learn from JFK
1 days ago
WHY WE CARE

Much has been made of David Brooks’s recent New York Times column, in which confesses to missing already the civility and humanity of Barack Obama, compared to who might take his place. In NewYorker.com, Jeffrey Frank reminds us how critical such attributes are to foreign policy. “It’s hard to imagine Kennedy so casually referring to the leader of Russia as a gangster or a thug. For that matter, it’s hard to imagine any president comparing the Russian leader to Hitler [as] Hillary Clinton did at a private fund-raiser. … Kennedy, who always worried that miscalculation could lead to war, paid close attention to the language of diplomacy.”

Source:
STAFF PICKS
Maher Weighs in on Bernie, Trump and Palin
1 days ago
WHY WE CARE

“We haven’t seen a true leftist since FDR, so many millions are coming out of the woodwork to vote for Bernie Sanders; he is the Occupy movement now come to life in the political arena.” So says Bill Maher in his Hollywood Reporter cover story (more a stream-of-consciousness riff than an essay, actually). Conservative states may never vote for a socialist in the general election, but “this stuff has never been on the table, and these voters have never been activated.” Maher saves most of his bile for Donald Trump and Sarah Palin, writing that by nominating Palin as vice president “John McCain is the one who opened the Book of the Dead and let the monsters out.” And Trump is picking up where Palin left off.

Source:
×