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Wednesday, September 25, 2013

Do we Have to Cancel Obamacare to Keep the Government Running? No.

Last Friday, the House voted — yet again — to defund the Affordable Care Act, aka Obamacare. In a creative twist, Republicans tacked the anti-ACA language onto the Continuing Resolution that provides funding to keep the government running.

What does this mean?
Continuing Resolutions are the stopgap funding mechanisms that Congress has been relying on since the sequester started, to keep programs running in the absence of traditional appropriations measures. The resolution must pass both houses of Congress, in some form that is acceptable to both.

So what will happen next is that the Senate will snip out the offending defunding language and send a "clean" version of the measure back to the House. Speaker Boehner could then bring it to a vote — thereby annoying the party's right wing — or majority leaders may try a slightly modified tack, perhaps finding some other aspect of the ACA law to challenge in the version they send back. It could bounce back and forth several times this way.

The deadline for the current Continuing Resolution is October 1st; if it is not passed by then, parts of the government will start to shut down. In particular, these will be the parts that are heavily dependent on year-to-year appropriations, such as the National Institutes of Health and the FDA. Cancer research could be jeopardized, drug approvals slowed, Social Security checks delayed due to staff being furloughed.

Won't shutting down the government bring Obamacare to a halt as well?
Not really, because the vast majority of the funding for implementation falls outside the annual appropriations process. In fact, on July 24, the Congressional Research Service responded to an inquiry from Oklahoma Rep. Tom Coburn on this very question, saying that by and large ACA implementation would be unaffected. Here are some of the highlights:
  • Medicare claims are paid from the Medicare Trust Fund, not annual appropriations
  • Changes to Medicare and Medicaid law are already in place
  • Many of the implementation grants to states have already been made
  • The IRS would continue to collect taxes and user fees
  • The individual mandate and health consumer protections are already in place (as matters of law, not funding)
  • Even in a "shutdown" there are provisions for essential services to continue
The full report is available here.

Last Friday's action was the 42nd time that congressional Republicans have voted to defund the ACA, and it is not the first time a government shutdown has been threatened. In 2011, a shutdown was narrowly averted, leading to the current "sequester." And the 1995-96 federal budget debates actually resulted in 28 days without non-essential services. Government funding is, in fact, only half the story; there is also the debt ceiling. In October, the nation's debt ceiling must be increased so that national bills can be paid. Failing to pay the already-accrued bills of the United States would have worldwide economic consequences. But the president has made it clear that he will not negotiate on the debt ceiling.

And what is our role, here on the ground?
Since there is no chance that the Senate will approve ACA defunding, the new approach, said Illinois Congresswoman Jan Schakowsky, will be to sow confusion. For example, there is already a major campaign to try to get young people not to enroll.

And that is why it is so important to get the word out. "We need to reach everyone," she said. "We have a week until launch day. But we have six months to get people enrolled." Rep. Schakowsky keeps an Obamacare Toolkit updated on her website. Rep. Schakowsky was a featured speaker at Monday's Statewide Conference Call Series organized by the Campaign for Better Health Care; the call focused on issues surrounding the threatened shutdown.

"One reason the Republicans do not want the ACA to go into effect is that they are assuming it will work," said Jennifer Beeson, Director of Government Relations at Families USA, another featured speaker. "Success is what will stop them."

But "we must remember how confused the American public is about this law, " said Beeson. "Many aren't even sure it's law." But "the law is real. It is in every state." The Families USA site features a Health Reform Central and state-by-state information.

The best time to reach people, Beeson noted, is when they are ready to take action — which is why the days ahead are so important. Starting next Tuesday, when people can go out and find out what is available to them, HHS will be doing targeted messaging to eligible groups; health districts and hospitals will have people available to counsel individuals; organizations and libraries will hold informational sessions. And we need to be ready on the ground with detailed information to provide outreach.

"Despite the obstructiveness and the rancor," said Rep. Schakowsky, "we are at the threshold of a very great moment."

Nina Sandlin
Guest Blogger for Health & Disability Advocates


  1. So we need to keep borrowing to make the government function. I sure would like to borrow continuously and spend freely and not worry about paying my bills and just let someone else I don't know pay them years from now. But Republicans say we can't keep spending more than we take in in tax dollars and a huge tax increase on the rich went into effect just a few months ago. Republicans want to cut spending on many government programs and all Obamacare spending to help balance the budget. Why don't Democrats strike back and tell us what social and other programs they want to cut instead to balance the budget? Or Democrats could instead announce that every program is needed and that every program is run at maximum efficiency and that every penny is spent wisely.

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