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
Add to Briefcase
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 »
STILL SKIPPING "DAVOS IN THE DESERT"
Mnuchin to Attend Saudi Terror Financing Meeting
44 minutes ago
THE LATEST

"Treasury Secretary Steven Mnuchin has decided to take part in an anti-terror finance meeting with Saudi security officials and their Middle Eastern counterparts in Riyadh later this month, opting to attend despite growing global outrage over the suspected murder of a U.S.-based journalist at the hands of Saudi operatives, according to three people familiar with his travel plans. The security gathering next week is separate from a Riyadh financial summit that Mnuchin announced on Thursday he would not attend."

ACCUSED OF HIDING DOCUMENTS ABOUT NASSAR'S ABUSE
Ex-USA Gymnastics CEO Indicted For Tampering With Sexual Assault Evidence
1 hours ago
THE DETAILS

"Steve Penny, the former president and CEO of USA Gymnastics, has been indicted on a felony count of tampering with evidence" in the sexual assault case against disgraced USA gymnastics physician Larry Nassar. Nassar was found guilty in January of sexually abusing dozens of young gymnasts, and was sentenced to 40 to 175 years in prison. Penny, who was arrested on Wednesday in Gatlinburg, Tennessee, "is accused of ordering the removal of documents from the Karolyi Ranch in Texas," where much of Nassar's abuse occurred.

Source:
HE MAY NOT AUTHOR A LARGE, SWEEPING NARRATIVE
Public May Not See Mueller Report
1 hours ago
THE LATEST

Defense attorneys involved in the Mueller probe say the public "shouldn’t expect a comprehensive and presidency-wrecking account of Kremlin meddling and alleged obstruction of justice by Trump — not to mention an explanation of the myriad subplots that have bedeviled lawmakers, journalists and amateur Mueller sleuths. ... Perhaps most unsatisfying: Mueller’s findings may never even see the light of day."

Source:
"UNLESS THE MIRACLE OF ALL MIRACLES HAPPENS"
Trump Acknowledges Khashoggi Is Dead
19 hours ago
THE LATEST

President Trump said that "unless the miracle of all miracles happens," that missing Saudi journalist Jamal Khashoggi is dead. Trump "expressed confidence in intelligence reports from multiple sources that strongly suggest a high-level Saudi role in Mr. Khashoggi’s assassination. [He] stopped short of saying the Saudi crown prince, Mohammed bin Salman, was responsible for Mr. Khashoggi’s death."

Source:
SAYS HE CONSULTED WITH POMPEO, POTUS
Mnuchin to Skip Saudi Investment Conference
1 days ago
THE LATEST
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login