Components of ACA Defunded

VII. Key Issues: Regulation & Reform >> C. Health Reform >> Affordable Care Act (ACA) >> ACA Repeal >> Components of ACA Defunded (last updated 1.4.15)

Overview

Congressional Research Service. Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act. February 5, 2014 – R43289 (available at OpenCRS). Table C-1 in Appendix C summarizes the ACA-related provisions in enacted annual appropriations acts for each of FY2011 through FY2014. Also included is a brief overview of all the ACA-related provisions added to appropriations bills considered, and in most cases reported, by the House and Senate Appropriations Committees since FY2011. The most recent update to this report (12.9.15) does not include this table, but includes a more abbreviated Table 1. Enacted Legislation That Modified, or Extended or Rescinded Funding for, Programs Established by the ACA

According to Washington Post’s Glenn Kessler at The Fact Checker, as of mid-July 2013, there had been only eight bills signed into law that cut various amounts of funding related to the ACA:

Specific Components Defunded

Defunding IRS Enforcement of ACA (4.15.11/12.23.11)

Defunding Prevention/Public Health Fund (2.22.12)

  • Statute. The Middle Class Tax Relief and Job Creation Act of 2012 signed by President Obama on 2.22.12, included reductions in funding for the Prevention and Public Health Investment Fund (PPHIF).
  • Savings. Congress cut $6.25 billion from the slush fund through 2021, and $2 billion each year thereafter (Galen Institute).

Defunding IPAB (12.23.11/3.26.13/12.18.15)

  • Statutes. Congress has three times cut funding for Independent Payment Advisory Board (IPAB).
  • Impact. According to Timothy Jost (12.16.15), “Medicare spending has not yet exceeded these targets and the IPAB has not yet been established. Presumably it will not be established during 2016, but the ACA gives the HHS Secretary authority to take action for the IPAB if it cannot make recommendations so this might not make much difference.”

Defunding “Louisiana Purchase” (7.6.12)

Defunding CO-OPs (12.23.11/1.2.13)

  • Statutes. Congress has cut CO-OP funding on several occasions:
    • On 12.23.11 Congress made cuts in funding to programs and agencies implementing the ACA including the CO-OPs (Galen Institute).
    • On 1.2.13, Congress cut an additional $2.2 billion from the “Consumer Operated and Oriented Plan” (CO-OP), which some saw as a stealth public option, blocking creation of new government-subsidized co-op programs. Early reports showed many co-ops, which had received federal loans, had run into serious financial trouble (Galen Institute).

Trimming the Medicare Trust-Fund Transfer (3.26.13)

  • Statute. Congress rescinded $200 million of the $500 million transfer from the Medicare Part A and Part B trust funds for the 5 year Community-Based Care Transition Program (Galen Institute).

Making the Risk Corridor Program Budget Neutral (12.16.14/12.18.15)

  • Statute. Congress has twice enacted statutes to ensure that the risk corridor program is budget neutral (as originally designed).
  • Impact. According to the law firm Crowell Moring, “HHS has stated that in the event of a shortfall, “HHS will use other sources of funding for the risk corridors payments, subject to the availability of appropriations.”
    • “Notwithstanding Congress’s refusal to appropriate funds for the risk corridors program, HHS has repeatedly acknowledged that the federal government remains on the hook for payments to insurers. Most recently, on November 19, 2015, HHS explained that, “HHS is recording those amounts that remain unpaid following our 12.6 percent payment this winter as a fiscal year 2015 obligation of the United States Government for which full payment is required.”
    • “If Congress continues to fail to appropriate sufficient funds to HHS for the risk corridors program, insurers could sue to collect, asserting that the amounts are an enforceable obligation against the U.S. Treasury under the Tucker Act. The Tucker Act, 28 U.S.C. § 1491, provides private entities that have claims for damages based on Federal contracts, statutes or regulations a right to sue for recovery in the Court of Federal Claims. Under the Tucker Act, the Court of Federal Claims has jurisdiction over claims against the United States founded upon the Constitution, a federal statute or regulation, or an express or implied contract with the United States. To state a cause of action under the Tucker Act, a plaintiff must identify a substantive right to money damages against the United States for which it has standing to sue. There are strong grounds for viewing ACA Section 1342 as creating a right to payment. Plaintiffs would also have to demonstrate that from a timing standpoint and otherwise the government has breached its obligations. Amounts awarded under the Tucker Act in the Court of Federal Claims are not subject to congressional appropriation limitations on agency funding and can be collected from the Department of the Treasury.”

Specific Components of ACA Proposed to be Defunded

Overview

Congressional Research Service. Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act. December 9, 2015. Table 2. ACA Provisions in Bills Approved by the House in the 112th, 113th, and 114th Congresses summarizes major ACA provisions in authorizing legislation that passed the House in 2011-2012 (112th Congress), 2013-2014 (113th Congress) and 2015 (114th Congress to date) but was not approved by the Senate.