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Health reform at center of budget showdown

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WASHINGTON — Battle lines were drawn as the October 1 opening of the Affordable Care Act’s health insurance exchanges approached.

House Republicans voted in late September to defund the ACA as part of a stopgap spending plan to let the federal government keep operating. The vote was 230 to 189, with two Democrats joining the majority and one Republican dissenting.

The action set the stage for a showdown over the president’s budget and its financing for the ACA, with the possibility of much of the government shutting down on October 1 — when the current spending authorization expires — and the country’s first default on federal debt weeks later.

“We’re going to continue to do everything we can to repeal the president’s failed health care law,” House Speaker John Boehner (R., Ohio) stated before the week of the vote. “The law is a train wreck. The president has protected American big business. It’s time to protect American families from this unworkable law.”

GOP representatives such as Tom Graves of Georgia cheered Boehner’s promise to link continued government funding to the health care reform law’s repeal, saying, “we are making a genuine attempt to stop the law before it starts on October 1.”

President Barack Obama said “a small faction” in Congress had needlessly intensified the debate over resolving the budget. “Initially, this was an argument about how much we spend on discretionary spending, how much do we spend on defense — you could sit down across the table, try to negotiate some numbers,” he said. “That’s no longer the argument. What we now have is an ideological fight that’s been mounted in the House of Representatives that says, ‘We’re not going to pass a budget and we will threaten a government shutdown unless we repeal the Affordable Care Act.’ ”

Obama said it was unprecedented for a budget to be contingent on “eliminating a program that was voted on, passed by both chambers of Congress, ruled constitutional by the Supreme Court,” was two weeks from being fully implemented, “and that helps 30 million people finally get health care coverage. You have never seen in the history of the United States the debt ceiling or the threat of not raising the debt ceiling being used to extort a president or a governing party, and trying to force issues that have nothing to do with the budget and have nothing to do with the debt.”

Rep. Steve Israel (D., N.Y.), chairman of the Democratic Congressional Campaign Committee, issued a tweet assigning the GOP move to the “Department of Wrong Priorities.”

Though House Republican resistance to a new budget can force a government shutdown, the ACA cannot be defunded without the backing of the Senate, where the Democrats are in the majority.

“Harry Reid will no doubt try to strip the defund language from the [House’s spending] resolution, and right now he likely has the votes to do so,” said Sen. Ted Cruz (R., Texas). “At that point, House Republicans must stand firm, hold their ground and continue to listen to the American people.”

Said Reid, “Any bill that defunds Obamacare is dead.”

Earlier, the House voted to advance legislation that would stop payments for ACA insurance subsidies until a system is in place to fully verify recipients’ eligibility.

The GOP sought to advance the bill to defy an Obama administration regulation giving states running their own exchanges some flexibility when checking whether people meet standards for subsidies. People can get subsidies if their employer does not offer an approved health plan and if their income is not too high. Republicans said the rule could let some ineligible people get subsidies, driving up the cost of the health care law.

“Because fraud and abuse have been rampant in just about every program that is administered by the Department of Health and Human Services [HHS], including Medicare and Medicaid, a certified verification system being in place prior to the implementation to the Affordable Care Act is critical,” said Rep. Michael Burgess (R., Texas). “The president’s strategy on the health care law is now: Trust, don’t verify.”

The Centers for Medicare and Medicaid Services (CMS) has said Republicans are exaggerating the regulation’s effect on subsidy eligibility. CMS notes that exchanges run by the federal government in more than 30 states will continue to run checks on income and insurance status.

The White House said HHS “has already put in place an effective and efficient system for verification of eligibility for premium tax credits and cost sharing reductions.” In addition, it said the bill creates “vague standards” that the government would have to adhere to in order to ensure eligibility, which would curtail access to health care.

The impact of the ACA will vary widely by state. Residents of states supporting the law will get protections and help unavailable to people in states fighting it. Californians, for example, will get extra help choosing a plan from community workers paid in part by foundations and the state.

But in states that have resisted the law’s implementation, there could be confusion and higher premiums for millions of residents. Among them is Florida, where the deputy health secretary ordered county health facilities to bar trained ACA outreach ­counselors.


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