Republican candidates across the country at nearly all levels of government voiced their opposition to healthcare reform and their support for repeal efforts. But every state in the union has received funding from the Affordable Care Act, including many whose governors have railed against it. So it’s reasonably clear that state-level Republicans certainly do not expect Congress to succeed in “defunding” healthcare reform.
Although “defunding” has famously been described as “Plan B” for squashing healthcare reform (see www.defundit.org.), the term is only a metaphor that helps rally the Tea Party. However, it won’t work, and the Republicans know it. Generally speaking, there are two types of spending for federal programs: discretionary spending and entitlement spending. Entitlement (mandatory spending) does not need to be appropriated by Congress each year; it’s automatic. Medicare and Social Security are only the most obvious examples of entitlement programs.
Discretionary spending is what Congress has direct control over. But the overwhelming majority of money in the Affordable Care Act is entitlement spending, which is not up to Congress to appropriate. Why? Because the funding is contained within the law. Approximately $50 to 80 billion is discretionary spending and needs to be approved by Congress. For the most part, it’s not pulling from general revenue. You can read more about this in a recent article in Health Affairs. (http://healthaffairs.org/blog/2011/01/04/funding-for-key-health-reform-provisions-less-endangered-than-you-might-think/)
Some prominent Republicans on the House Appropriations Committee have suggested they could pass language in the appropriations bills this year forbidding the Department of Health and Human Services (HHS) from implementing reform. However, such instructions are not legally binding, and HHS along with other executive-branch departments has wide latitude to set its own internal budgets, including moving money from one project to another. Essentially, Congress would need to defund all of HHS.
Oh, and did I mention that appropriations bills must also be passed by the Senate and signed by the President?
So what’s really going on? Stay tuned. We just may find out!