There was a lot of bark but not much bite this week in Congress surrounding the Affordable Care Act.
In a Senate Appropriations Subcommittee hearing, HHS Secretary Sebelius once again defended the ACA against attacks from opponents, including one who was concerned that it was “too popular”. Chairman Tom Harkin (D-IA) reassured the Secretary of his commitment to block any attempts to defund the law through the appropriations process.
“I also want to assure you that as long as I am chairman of both this appropriations subcommittee and the HELP Committee, your department will continue to receive the resources you need to implement the Affordable Care Act. The American people will not allow the hard-earned protections and benefits in this law to be taken away. And neither will we.”
The House Energy and Commerce Health Subcommittee held a hearing on aspects of the Affordable Care Act and a mark-up on legislation to remove the mandatory funding included in the ACA. On Wednesday, the panel, chaired by Rep. Joe Pitts (R-PA), heard testimony from CBO Director, Doug Elmendorf, and CMS Chief Actuary, Rick Foster. Neither offered new analyses of the law but instead discussed their earlier findings. On Thursday, the subcommittee approved five bills that attempt to block the mandatory spending included in the ACA. This is just the first step in the legislative process. The five areas of funding that would be impacted should the legislation ever become law are: state-based exchange grants, school-based health centers, personal responsibility education, teaching health centers and the Prevention and Public Health Fund.
Looking ahead to next week:
The Senate postponed until next week a vote on the bill to eliminate the 1099 reporting requirements in the ACA. Some are already characterizing the 1099 legislation as a step toward repeal when in reality, it’s a signal that by working together in a bipartisan fashion, Congress can revise provisions of the new law to make it work better. Nobody said the Affordable Care Act was perfect but it is certainly far better than the system we had before. (CCF has previously raised concerns about the pay-for being used to offset the revenue lost by changing the 1099 provision.)
House Budget Committee Chairman Paul Ryan (R-WI) is expected to release his proposed budget resolution early next week. It’s anticipated that the bill will propose deep cuts to Medicaid and other vital programs. For an indication of Chairman Ryan’s views on health care coverage, I refer you to his “Roadmap for America’s Future” document in which he called for converting the federal contribution of Medicaid into grants of $11,000 per year per recipient to purchase private insurance. The budget resolution won’t get into that level of detail but will set broad spending guidelines and Ryan has made it clear he will target Medicaid and Medicare for deep cuts (as much as a $1 trillion cut to Medicaid over 10 years according to Politico).
House Budget Committee Ranking Member Chris Van Hollen (D-MD) has vowed to fight efforts to dismantle the Medicaid program.
“Block granting Medicaid is simply code for slashing health care support for seniors, people with disabilities, and others. It is not reform. It does nothing to reduce health care costs. It simply gives governors a blank check and a license to deny critical care to millions of seniors and to people with disabilities.”
While the Budget Committee debates FY2012 funding levels, the House and Senate leadership are engaged in behind-the-scenes negotiations on FY2011 funding as the short-term Continuing Resolution, which is keeping the government open, expires on April 8.