When the appropriations bill passed through Congress, Republicans and Democrats both claimed victory on provisions related to the Affordable Care Act. Republicans touted small cuts aimed at the law's implementation, while Democrats crowed that the law's funding was protected.
A closer examination of the legislation shows a much more nuanced outcome, in which Republicans did get some of the cuts they wanted — just not all those they're taking credit for.
There's actually very little appropriators can do to stall the health care law, said Republican Rep. Jack Kingston, who heads the House Appropriations subcommittee that deals with the Health and Human Services Department.
Most of the funding for the law is mandatory, not discretionary, leaving GOP appropriators with few options when it comes to depleting the law's resources.
But Kingston said they cut what they could.
"The Obamacare bill when it was passed actually advance-funded its appropriations and the mandatory doesn't come under our bill," he said. "Any funding that was channeled into implementing Obamacare, we have cut."
Democrats disagree, arguing that funding for the law and its implementation is nearly equivalent to what Congress authorized in fiscal 2013.
What actually happened is that Republicans have said repeatedly that the omnibus spending bill cuts $1 billion from the Prevention and Public Health Fund, a program within the Affordable Care Act that is designed to provide funding for prevention and wellness initiatives. While the bill provides the full $1 billion requested for the PPHF for the current fiscal year, it also allocates those resources to specific disease-prevention programs, prohibiting the Obama administration from using the funding to offset the costs of implementing the health care law.
Worried that HHS Secretary Kathleen Sebelius was using it as a "slush fund" to provide extra money to pay for implementation, Republicans included a provision that specifically allocates every cent for fiscal 2014 to a variety of prevention and wellness programs, including diabetes, heart disease, and cancer prevention programs. The department also has to account for every transfer.
The move allowed lawmakers in both parties to declare victory.
Sen. Tom Harkin of Iowa, Kingston's Democratic counterpart on Senate Appropriations and the author of the PPHF portion of the Affordable Care Act, said this marks the first time Congress has fully appropriated resources for the fund since the law passed in 2010. The fund was raided in 2012 to pay for the Medicaid "doc fix" and in 2013 to help pay for enrollment efforts under the health care law.
"As the author of the fund, I consider the allocation of these resources to prevention and wellness as a major achievement in this bill," Harkin said on the floor last week. Health care groups were also enthusiastic about the provision.
In terms of other implementation funding, the bill does provide $2.5 billion for "program operations" at the Center for Medicare and Medicaid Services, one of the primary accounts from which the administration has drawn implementation funds. Kingston points out that the money is $1.5 billion less than HHS requested in the president's 2014 budget. But the funding for the program is actually set at exactly the same allocation HHS was given in fiscal 2013.
Still, Republicans did get one clear victory in working to undermine the Affordable Care Act: The bill cut $10 million from the Independent Payment Advisory Board, a controversial provision of the law. The board is charged with making binding recommendations to Congress for reducing Medicare costs beginning in fiscal 2015, but it has been lambasted by conservatives as a "death panel" and a bureaucratic exercise.
Republicans have touted the IPAB cuts, but Democrats have said little about the issue.