What If ACA Opponents Win the Election?

This is Henry J. Aaron, writing in the New England Journal of Medicine:

Customarily, substantive legislation “authorizes” spending, but the funds to be spent must be separately “appropriated.” The ACA [Affordable Care Act] 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. The ACA appropriated nothing for the Internal Revenue Service, which must collect the information needed to compute subsidies and pay them…

If ACA opponents gain a majority in either house of Congress, they could not only withhold needed appropriations but also bar the use of whatever funds are appropriated for ACA implementation, including the implementation of the provisions requiring individual people to buy insurance or businesses to offer it. They could bar the use of staff time for designing rules for implementation or for paying subsidies to support the purchase of insurance. They could even bar the DHHS from writing or issuing regulations or engaging in any other federal activity related to the creation of health insurance exchanges, even though the ACA provides funds for the DHHS to make grants to the states to set up those exchanges.

Comments (7)

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  1. Ken says:

    Very interesting post. Apparently Republicans and moderate Democrats can do a lot to interrupt the process.

  2. Stephen C. says:

    This shows the foolishness of one party thinking it can reform the health care system without any agreement from the other party.

  3. Vicki says:

    This post put me in a much better mood.

  4. Devon Herrick says:

    I’ve heard about this argument before — failure to appropriate funds as a strategy to prevent implementation. I’d rather have a reform bill that all parties agree on rather than a bad bill that is not funded.

  5. David Greene says:

    That’s the plan. Defund the whole thing first, repeal in 2012 unless they manage to kill it beforehand.

  6. Larry C. says:

    This gives me hope.

  7. Like Devon Herrick, I intensely dislike laws that are not enforced. Starving the appropriations is a good start, but they have to keep the momentum up towards repeal.

    If I were a political animal, I’d recommend they pass a bill restoring the Medicare cuts, funded by eliminating the subsidies to the exchanges. That would be a tough one for the President to veto.