DC Republicans in Full Panic Mode: Obamacare Will Be Hugely Popular and There's Little the GOP Can Do to Stop It

Personal Health

There are bottom lines behind Congress’ latest Obamacare gyrations that are easy to miss as the most desperate Republicans keep threatening to kill the health insurance law by defunding it.

They can’t stop it from taking effect, just as they haven’t been able to repeal or defund it in every federal budget fight since it passed in 2009—including their latest rants.

Moreover, there’s billions already in the fiscal pipeline to states to implement the health insurance market reforms, whether or not there’s a federal government shutdown. Thus, their posturing, such as Texas Sen. Ted Cruz’s latest bill for complete defunding and his Tuesday filibuster, needs to be seen as the old cliché it is: a desperate measure for their desperate time.

What’s scaring Republicans is that the president’s most significant domestic initiative is about to hit prime time. Starting October 1, it is poised to start delivering on its central promise, which is giving millions of Americans more and cheaper choices to buy health insurance. These policies would be obtained from state-run insurance pools, or by a federal-run pool that would be accessed in person or online, and will take effect January 1. Poor people get tax refunds to buy insurance, although those won’t be seen until after next year’s taxes. 

Republicans fear the law will find more supporters than critics. That’s why Democrats should be excited, because an often centrist president has enlarged the safety net for the poor and created a new system to get healthcare at a cheaper price than the insurance industry was willing to provide.

“There’s a ton of money for an indefinite time for the grants to the states to create and run the [insurance-buying] exchanges,” said C. Stephen Redhead, a Congressional Research Service analyst who has authored numerous reports about funding Obamacare in recent budget cycles. “A lot will depend on the effort that the state itself is willing to make.”

Redhead is referring to what states are and aren’t doing to publicize the government-run health insurance marketplaces. But whether your state has embraced the reforms, such as California, which received nearly $1 billion from Washington to get started, or has done next to nothing, such as in Virginia and Florida (meaning federal agencies will fill that void) is a separate issue from whether the insurance reforms are coming.

Redhead’s Congressional Research Service reports describe all of this in great detail. It’s true that Republicans have been able to chip away around edges of the law. But they have not stopped it. Perhaps their biggest dent was taking a $6.25 billion bite out of FY2013-FY2021 appropriations for a big healthcare fund to extend a payroll tax cut in 2012. However, that came from $16.75 billion the law gave the federal Prevention and Public Health Fund for that period, which is distributed among dozens of programs.

The Affordable Care Act is so big and so much of it is funded in perpetuity—like other federal entitlements—that the Obama administration has been able to move around piles of money to get it started, Redhead said. He compared Obamacare’s launch to how Medicaid, the state-run program for low-income and disabled people, began in 1965.

“Lots of states grumbled and complained,” he said. “It was optional for states. But they all did it eventually. The last holdout was Arizona. It joined in 1982, 17 years later.”

In recent federal budget fights, House Republicans have repeatedly tried to defund the so-called discretionary funding items in the law, such as all kinds of demonstration projects to develop new models for preventative care, community-based care, as well as projects to track and cut costs, and to experiment with new payment systems.

“Most of that stuff is largely irrelevant or completely incidental to the core premises of the Affordable Care Act,” Redhead said, adding that many of those projects were added by individual members for their home districts. “The ACA is like the Bible. Calling it a law is like calling the Bible a book. You have lots of books in the Bible, including stuff on the Old Testament that no one ever looks at.”

The heart of the ACA concerns a handful of core ideas about restructuring private health insurance markets, he said. There’s the creation and introduction of new government-run exchanges where individuals can buy insurance, where in the past they would be denied coverage or have had to pay higher rates. There is the coverage mandate, or requirement that every adult have health insurance. There also is the expansion of Medicaid to give lower-income people access to subsidized insurance. There also are new pathways to access care, such as community clinics and other patient-centered options.

When Washington insiders look at the many ways the Obama administration has moved money around to implement the cornerstones of the ACA, they see an executive branch that has not been detered by GOP protests, Redhead said. Some of his colleagues say the administration has taken too many liberties, he said; however, those kinds of administrative acrobatics are nothing new in government.

As has been the case in every budget fight since Obamacare passed, the Republican-led House hasn’t gotten anywhere with defunding or repealing it, as CRS reports note in detail. Moreover, the U.S. Supreme Court has upheld it, although they did say states not implementing the expansion of Medicaid would not be penalized.

That means Americans will soon see what Obamacare is about and what impact it has in their lives, regardless of the GOP’s continuing noise about crippling or killing the law.  

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