The ACA’s Achilles heel

The following has been cross posted at The New Republic’s Citizen Cohn.

Earlier this week Jennifer Haberkorn reported in Politico that Republicans plan to use their expected mid-term political mandate to choke off funding for provisions of the Affordable Care Act.

Republicans would be able to deny funding only to the pieces of the law that require money from Congress. Doing so could create “Swiss cheese” out of the legislation, with some portions of the law already being funded and others not. …

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.

Make no mistake, repeal by purse strings could create a mess. The law has many moving parts that act together to create a sensible, complete whole. And implementing a piece of legislation as complex as the ACA requires fully funding the agencies that oversee it. So, this strikes me as the most politically viable, serious attack on health reform.

I’ve thought as much for a while. Back in December 2009 I wrote,

To the extent we hear more about health reform it will be for one reason: the money. While the legislation may be internally balanced so it scores as deficit reducing, it will not be viewed as monolithic once it passes. It has both spending and savings. Could we keep the savings and gut the spending? Sure.

Who would do that, and why? Answers: Republicans, for tax cuts. While the former are out of power, that won’t last forever. And the latter are always popular. This reform will be attacked. Things may quiet down, but this is not the end of it. Money has a way of drawing attention and a crowd.

The combination of “savings” created by failing to fund implementation and tax cuts is likely to appeal to the Republican base. Keep in mind that the ACA does very little for the broad middle-class of voters who are covered in the large-group market. In these hard economic times, such voters may prefer some money in their pockets than additional spending on a program for which they expect little benefit. (Of course losing one’s job jeopardizes one’s insurance so the ACA really does add a meaningful layer of protection for all Americans.)

So, I worry about this. The legislation may be Democratic sausage, but I prefer it to the Swiss cheese the Republicans intend to dish up.

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