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.