Chen Lin's List: PS103 Analytical Paper 3

• Among the discrete provisions Republicans have discussed putting on the chopping block is the "individual mandate," which requires virtually all Americans to obtain health insurance or pay a tax penalty
• Republicans could succeed in eliminating unpopular aspects that are less central to the law. A case in point is the "1099" provision,
• The most substantial federal expenditures required by the law - the expansion of Medicaid contributions to help states cover a greater share of the poor, for instance, or federal subsidies to help individuals buy private insurance - won't begin until 2014. And their funding sources were essentially locked in and automated by the law and will not be subject to Congress's annual appropriations process over the next two years.
• HHS Secretary Kathleen Sebelius has said that even if her agency were not optimally funded over the next two years, she could find the staff and the means to continue implementing the law.
• the Republicans' newfound opportunity to hold hearings showcasing what they consider downsides of the law could be their most effective means of dismantling it; the hearings could lay the groundwork for a broad-based public repudiation of legislation that still divides Americans.

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• The House Republican whip, Representative Eric Cantor of Virginia, described the strategy this way: “If all of Obamacare cannot be immediately repealed, then it is my intention to begin repealing it piece by piece, blocking funding for its implementation and blocking the issuance of the regulations necessary to implement it.”
• The Senate Republican leader, Mitch McConnell of Kentucky, said he, too, wanted to shut off money for the new law.
• By attaching the restrictions to appropriations bills, House Republicans can force negotiations with the Senate. The Hyde amendment, restricting the use of federal money to pay for abortion, began as such a rider more than 30 years ago.

• the law provided $1 billion for “federal administrative expenses.” But that is far less than will be required.

   The Congressional Budget Office says the Internal Revenue Service will need $5 billion to $10 billion over 10 years to determine who is eligible for tax credits and other subsidies intended to make insurance affordable. The Department of Health and Human Services will need at least that much to carry out changes in Medicaid, Medicare and the private insurance market, the budget office said.

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• Mr. Obama mentioned one example, saying he would accept changes in a provision that imposes a huge information-reporting burden on small businesses. Under the provision, businesses would generally have to file 1099 tax forms identifying anyone to whom they had paid $600 or more for goods or services in a year.

• A top priority, Mr. Gelfand said, would be to alter or eliminate a provision that will require many employers to contribute to the cost of coverage for employees. The requirement, he said, would hurt job creation and increase the cost of hiring workers.

   Some labor unions may join employers in trying to roll back a new tax on high-cost, employer-sponsored health plans, scheduled to take effect in 2018. Several Republicans said they would try to reduce or repeal a new tax on manufacturers of medical devices.
• Some labor unions may join employers in trying to roll back a new tax on high-cost, employer-sponsored health plans, scheduled to take effect in 2018.
• Republicans said they would try to cut the budget for federal enforcement of the law and related rules.

• Republicans said they might agree to keep popular provisions of the new law, like protections for people with pre-existing medical conditions, while trying to scrap unpopular provisions, like the requirement for people to carry insurance. However, administration officials and insurance executives said such a combination would not work in practice.

   

      

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• The nonpartisan Congressional Budget Office estimated that Congress controls $115 billion over 10 years to cover the cost of the agencies implementing the law, as well as funding for programs and grants that have a specified funding amount in the law. The CBO wasn’t able to estimate how much it would cost to implement other programs and grants in the law that weren’t given a specific funding level.

   Thus far, Republican efforts to repeal or defund the law have fallen largely on deaf ears. A Kaiser Family Foundation poll released Thursday found that 35 percent of the public opposes the law, down from 41 percent last month. Those who oppose the law overwhelmingly support repealing it. Support for the health care plan has hovered at about 50 percent.

   

• The nonpartisan Congressional Budget Office estimated that Congress controls $115 billion over 10 years to cover the cost of the agencies implementing the law, as well as funding for programs and grants that have a specified funding amount in the law. The CBO wasn’t able to estimate how much it would cost to implement other programs and grants in the law that weren’t given a specific funding level.

• Customarily, substantive legislation “authorizes” spending, but the funds to be spent must be separately “appropriated.” The ACA contains 64 specific authorizations to spend up to $105.6 billion and 51 general authorizations to spend “such sums as are necessary” over the period between 2010 and 2019. None of these funds will flow, however, unless Congress enacts specific appropriation bills. In addition, section 1005 of the ACA appropriated $1 billion to support the cost of implementation in the Department of Health and Human Services (DHHS). This sum is a small fraction of the $5 billion to $10 billion that the Congressional Budget Office estimates the federal government will require between 2010 and 2019 to implement the ACA.⁴ The ACA appropriated nothing for the Internal Revenue Service, which must collect the information needed to compute subsidies and pay them. The ACA also provides unlimited funding for grants to states to support the creation of health insurance exchanges (section 1311). But states will also incur substantially increased administrative costs to enroll millions of newly eligible Medicaid beneficiaries. Without large additional appropriations, implementation will be crippled.

   

• That would set the stage for a high-stakes game of political “chicken.” The president could veto an appropriation bill containing such language. Congress could refuse to pass appropriation bills without such language. Failure to appropriate funds would lead to a partial government shutdown. In 1994, leaders of the Republican Congress who pursued a similar tactic during the Clinton administration lost the ensuing public-relations war. In the current environment, however, one cannot be certain how political blame — or credit — for such a governmental closure would be apportioned or which side would blink first.

   

• Whatever the outcome of such a political contretemps, debate over the ACA is certain to continue. Opponents can take political comfort in polls reporting that nearly half of Americans say that Congress should repeal most of the ACA and replace it with something else.⁵ Since most major provisions of the ACA do not take effect until January 1, 2014, delaying tactics might eventually enable repeal. Electoral gains in 2010 will embolden ACA opponents. They will continue the fight on into the 2012 presidential and congressional campaigns. To be sure, this debate would give ACA supporters the chance to dispel the confusion and correct the misinformation on which much of the public opposition to the law is based.

   

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