Countdown to shutdown over Obamacare: time to panic?
This article was originally published in Clinica
Congress has less than two weeks to either reconcile House and Senate fiscal year 2014 budget bills adopted earlier this year – a deal seen by most in Washington as highly unlikely to happen – or agree on a short-term continuing resolution (CR) before US federal agencies, like the FDA and the National Institutes of Health, are forced to shut down, resulting in delayed drug and device approval decisions or a slowdown in research grant awards.
Meanwhile, the US is expected by mid-October to reach its debt limit, which must be raised for the government to continue to pay its bills.
But a faction of Republicans are continuing their fight to hitch defunding or delaying the Affordable Care Act (ACA), commonly known as Obamacare, to the spending and debt ceiling measures – putting House Speaker John Boehner (Republican-Ohio) in a tricky position. Speaker Boehner last week insisted the goal of his colleagues was not to shut down the government, but to stop the ACA and to cut spending.
But Mr Boehner was forced on 11 September to delay a vote on a Republican-proposed nearly $1tn CR after failing to gain the support of members of his own party, who said the Obamacare defunding measure in the bill could easily be sidelined by the Democrats in the Senate.
While House Minority Leader Nancy Pelosi (Democrat-California) said Republicans were not able to "get their own act together" as the government shutdown looms nearer, Representative Hal Rogers (Republican-Kentucky) insisted it was "not time to panic," even though the House has very few days scheduled to meet before 1 October.
"The fact is, Speaker Boehner has to decide what kind of speaker he wants to be. He can be a speaker who governs and achieves success by getting Democratic votes to continue government operations and to raise the debt limit or not," Representative Donna Edwards (Democrat-Maryland) said on 15 September on ABC's Sunday political program This Week.
The Republican-controlled House has voted 41 times over the past few years to defund, delay or repeal the 2010 ACA, with the most recent measuring winning support in a 235-191 vote on 12 September.
The No Subsidies Without Verification Act (HR 2775), sponsored by Representative Diane Black (Republican-Tennessee) would require health insurance exchange subsidies to be held up until a stronger verification system was put in place.
The subsidies are for Americans who meet certain criteria, such as a low-income level. The Department of Health and Human Services (HHS) in July issued a regulation intended to give state-run exchanges flexibility in determining eligibility for the subsidies.
Republicans, however, asserted the regulation, which permits HHS to rely on self-attestation and sample government audits, lacks protections to ensure those ineligible for the subsidies are not obtaining them. "It opens the door a mile wide to fraud and abuse," Representative Black contended.
The insurance exchanges are expected to be a boon to drug makers, because prescriptions of their products are more likely to be filled by those Americans covered by health insurance than those who are not.
Representative Justin Amash (Republican-Michigan) argued his party was "doing the president a favor" if they succeed in delaying the ACA because it is "not ready to be implemented."
"If anything, the president should be asking us to delay it because it's better for him politically," Mr Amash said on 15 September on ABC's This Week.
But on the same program, President Barack Obama pointed out that, in the past, budget negotiations and raising the debt ceiling were not hinged on "wiping away" major pieces of legislation, like the ACA. "That's never happened before," President Obama said. "When it comes to budgets, we've never had the situation in which a party said…'unless we get our way 100%, then we're going to let the United States default.'"
The ACA, the president said, is about "making sure that folks who have been left out in the cold when it comes to health care are able to get health care."
While Republicans have insisted insurance premiums are on the rise because of the ACA, HHS in a 12 September report said the law's "rate review" provision – which requires insurers to review and justify any proposed rate hikes of 10% or more – saved 6.8 million Americans $1.2bn in 2012.
In a 15 September report marking the fifth-year anniversary of the collapse of Lehman Brothers, which is viewed as the trigger that unleashed the worse financial crisis the US has faced since the Great Depression, the White House insisted the ACA gave families "additional security" during the rocky economic times.
"Thanks to the grit and resilience of the American people, we've cleared away the rubble from the financial crisis and begun to lay a new foundation for stronger, more durable economic growth. And the last thing we can afford right now is a decision from Congress to throw our economy back into crisis by refusing to pay our country's bills or shutting down the government," the White House argued in its report.