House Joint Resolution 59, adopted by the House on September 20, provides “Notwithstanding any other provision of law, no Federal funds shall be made available to carry out any provisions of” the Affordable Care Act or the health provisions of the Health Care and Education Reconciliation Act.” It further states, “No entitlement to benefits under any provision of” those laws “shall remain in effect on and after the date of the enactment of this joint resolution, nor shall any payment be awarded, owed, or made to any State, District, or territory under any such provision.”
As is well known, the Affordable Care Act is hundreds of pages long and contains provisions affecting nearly every aspect of our health care system. These provisions address not only access to health care for millions of uninsured Americans, but also Medicare, Medicaid, fraud and abuse, the health care workforce, prevention and wellness, reform of Native American health care, and access to generic biologics.
Defunding is obviously intended to block implementation of the individual and employer mandates and the premium tax credits—the provisions that have drawn the ire of House Republicans and their constituents. But it would also reverse the implementation of provisions closing the Medicare prescription drug “doughnut hole” and expanding preventive services under Medicare, affecting millions of Medicare beneficiaries. Indeed, it could, according to Health and Human Services Secretary Sebelius, end payments for Medicare Advantage plans and other Medicare providers, since payments are currently being made under payment rules promulgated to incorporate changes under the ACA. These rules include enhanced payments to rural and primary care providers under special ACA programs.
Defunding would block the federally funded expansions of Medicaid to cover all children and adults under age 65 with incomes not exceeding 133 percent of the poverty level, which otherwise would go into effect in half the states on January 1. It would immediately cut funding for the highly successful Children’s Health Insurance Program (CHIP) by 70 percent, threatening the health care of millions of children in all of the states. The House action could also adversely affect the delivery of health care to Native Americans by eliminating funding for the implementation of and benefits provided by the Indian Health Care Improvement Act, which was part of the ACA.
The delivery of health care to medically-underserved people by federally qualified community health centers would be slashed by a nearly 60 percent reduction in federal funding. Funding for the National Health Service Corps would be eliminated, as would the Early Childhood Home Visiting program for at-risk children. The Pre-Existing Condition Insurance Plan Program, which covers over 90,000 Americans, would immediately close its doors. Defunding would terminate grants and loans to thousands of health professionals in training. The House-passed continuing resolution would cut funding for the anti-fraud efforts of the HHS Office of Inspector General, the Centers for Medicare & Medicaid Services, and the Department of Justice, increasing the cost of federal and state health care programs.
Finally, defunding the ACA without the repeal of the ACA’s insurance reforms would mean that insurers in the individual market would face guaranteed issue, community rating, and a ban on preexisting condition clauses as of January 1, 2014, with no individual or employer mandate and no premium tax credits. This could effectively destroy the individual insurance market in the United States.
In sum, “defunding Obamacare” is a reckless action that would wreak untold damage to our health care system and to the health care of millions of Americans. If House Republicans have serious proposals for improving health care reform, these should be considered. But shutting down the government over a proposal without any discussion of the consequences of that action is the height of irresponsibility.
Jost holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law. He is a co-author of a casebook, Health Law, used widely throughout the United States in teaching health law. He is also the author of several books on health law, health care and insurance.