Over at the Health Affairs blog, Melissa Seeley argues that the GOP’s threats of defunding health reform — once outright repeal fails — may be louder than its bite, since the Obama Administration “already has much of the funding it needs to carry out the main elements of reform”:

The pillars of the law’s health insurance expansion strategy—increased eligibility for Medicaid and the new premium and cost-sharing subsidies for private health insurance—are exempt from the annual appropriations process. These so-called “mandatory” or “entitlement” programs are permanent and have permanent funding authority. Furthermore, the Department of Health and Human Services has the ability to fund related provisions without seeking additional appropriations from Congress. For example, Federal grants to states to plan and build the new health insurance exchanges fall into this category. It also includes funding necessary to immediately lower insurance costs for uninsured individuals with preexisting conditions and early retirees.

Indeed it’s an argument we’ve heard from Democrats before. In December, after Senate Majority Leader Harry Reid (D-NV) dropped the omnibus spending package that included some $1 billion in funding for health reform and instead opted for a much smaller continuing resolution (CR) to extend federal spending authority into the new year, HHS Secretary Kathleen Sebelius argued that “the initial Affordable Care Act passed with some resources included in the bill and we’re going to continue to implement the law.” Similarly, Tom Daschle explained to me that “A lot of what we did in health care reform has more of an entitlement than a discretionary funding base. So as an entitlement, they would really have to change the law rather than simply not fund in order for it to be effected. The entitlement sections of the legislation are going to be fairly immune from defunding.”

All of this is true, but it’s unclear what happens after the current CR expires in March or if Republicans try to shut down the government over the debt ceiling vote.

Yesterday, Jonathan Chait warned Democrats that they need to sharpen their message against the GOP’s campaign to repeal health care reform if they hope convince the public that the law is worth preserving. “If you shrug it off as a meaningless symbolic vote, then why not go ahead and vote yes?,” he asks. “In fact, Democrats have a strong response. Republicans are voting to open up the donut hole for Medicare recipients and charge them higher rates, allow insurance companies to turn away anybody whose family has a preexisting condition, and all sorts of awful things.”

Unwrapping the individual provisions of reform from the law as a whole and the process it took to pass it has always been an effective messaging strategy, one that incoming House message guru Rep. Debbie Wasserman-Schultz (D-FL) deployed rather skillfully this morning during her CNBC debate against Rep. Tom Price (R-GA):

WASSERMAN-SCHULTZ: The Republicans will take away a 50 percent cut in brand name drugs that seniors got…it will mean that children and in a few years everyone will be dropped or be denied coverage for the pre-existing condition that they might have. It will mean that young adults will no longer be able to stay on their parents’ insurance until they’re 26. …. What we’re going to do is put insurance companies and profit-driven decision making back in the driver’s seat, instead of decision making between doctors and their patients.

PRICE: That’s the kind of policy that was rejected on November 2nd.

WASSSERMAN-SCHULTZ: Really? Really? You think that people want insurance companies, Tom. You think that Americans want insurance companies to make decisions about whether or not they get coverage for a pre-existing condition? That is absolutely not what November 2nd was about.

Watch it:

It’s also worth pointing out that the Republican repeal legislation is actually a major cop-out. Rather than proposing an alternative for the very sickest Americans who are now enrolled in reform’s high risk insurance pools or the small businesses who are benefiting from the small business tax credits, the GOP replacement legislation instructs the health committees to develop alternative solutions and report back to the full House. The maneuver shields the bills from any detailed criticism — Republicans presumably want to avoid the kind of backlash that their initial alternative generated — but it also suggests that the party has nothing immediate to offer to those Americans who are already benefiting from reform’s early consumer protections and programs.

Last night, without holding hearings, seeking “bipartisanship” or even scoring the legislation at the Congressional Budget Office (CBO), House Republicans posted two separate 2-page bills repealing the entirety of the Affordable Care Act and promised to hold a vote on the measures on Wednesday, January 12th. The Rules Committee will meet as early as Thursday of this week and could vote on the rules for considering the legislation on Friday.

The two repeal measures don’t appear to have CBO scores attached to them, but the budget office has previously estimated that eliminating the entirety of the health care law would add $143 billion to the deficit over 10 years. As a result, the GOP is excluding the vote from its new cut-go rule — under which increases in mandatory spending would have to be paid for but tax cuts would not — and dismissing the CBO’s estimates of savings in the health law. But this places the new majority at odds with the ‘Gods’ at the CBO — who they’ve routinely cited to bolster their own proposals — and its repeated pledges to lower spending in the new Congress. Below is just a sampling of Speaker-elect John Boehner’s (R-OH) commitment to “kick ass” on the spending issue:

- “I think it’s time for Democrats here on Capitol Hill to start listening to the American people. They want spending cut and they want it cut now. And I’m wondering, why isn’t the president looking for someone’s ‘ass to kick’ on this subject?” [Statement, 6/9/2010]

- “If we want to solve the budget problem, we’ve got to have a healthy economy and we have to get our arms around the runaway spending that’s going on in Washington, D.C.” [MTP, 8/8/2010]

- “I think the other thing that has to happen is that we’ve got to cut spending. If we cut spending we will help our economy, we will send signals to the markets, we will send signals to the business community, that Washington’s attempting to get its fiscal house in order.” [FTN, 12/2/2010]

During the 112th Congress, Republicans also criticized Democrats for excluding certain provisions from the pay-go rule (which required Congress to offset tax cuts or spending increase for a mandatory program with cuts in other mandatory spending or increases in other taxes) and designed a PAYGO tracker to tally when “PAYGO has been waived, gamed, ignored, or employed to justify billions of dollars in new spending and tax and fee increases.” “PAYGO has enabled hundreds of billions of dollars in deficit increases mainly due to generous loopholes allowing the majority to satisfy the procedure’s technical requirements, and erect a facade of fiscal responsibility,” incoming Budget Committee Chairman Paul Ryan (R-WI) complained in October.