Republican Health-Care Attack Shifts From Defund to Delay

Republican congressional leaders, in a fresh strategy after repeatedly failing to dismantle President Barack Obama’s health-care law, are leaning toward an effort to postpone it rather than choke off funding.

Freshmen Senators Ted Cruz of Texas and Mike Lee of Utah have commanded the spotlight during this month’s congressional recess, saying they want to shut down the government unless the law is defunded. Most of their colleagues haven’t joined them. “Far too many Republicans are scared of this fight,” Cruz said yesterday on Rush Limbaugh’s radio talk show.

Instead, House and Senate Republicans probably will try to force the law’s delay as part of the debate starting next month over funding the U.S. government and raising the nation’s debt ceiling, according to interviews with aides and lawmakers.

This would be a significant shift as the Republican-led House has focused on draining funds for the Affordable Care Act. Since 2011, the House has voted 37 times to repeal or defund the measure, a proposal the Senate won’t consider.

“As a matter of fairness, if businesses and insurance companies are getting a delay, it’s only right for the American people to get a delay,” said Representative Tom Price, a Georgia Republican and former chairman of the Republican Study Committee, which calls for limited government. “It’s not going to work in its current construct.”

The Obama administration announced July 2 that it would postpone for a year the law’s requirement that companies with 50 or more workers provide health insurance to employees. The administration is moving ahead with the individual mandate requiring most Americans to carry health insurance.

Fiscal Year

Congress must renew government funding when the new fiscal year starts Oct. 1, which is also when uninsured Americans and small employers may start purchasing coverage through exchanges, or Internet-based marketplaces for health insurance.

The fight to overturn the health-care law has united the Republican Party and helped lawmakers win elections in the past two congressional campaigns. Now divisions over continuing the strategy may lead to more intra-party challenges.

House Speaker John Boehner, an Ohio Republican, refused during a conference call last week to commit to demanding the law be defunded during the budget negotiations. The tensions risk weakening the Ohio Republican’s position in negotiations with Democrats.

Republican approval ratings fell after a standoff in 2011, when Republicans risked a default on the nation’s debt to force cuts in government spending.

Conservatives Fund

The Senate Conservatives Fund is running ads against Republican senators who won’t support the Cruz-Lee effort, including Lindsey Graham of South Carolina and Senate Minority Leader Mitch McConnell of Kentucky.

In the House, activists are taking a new approach to forcing Boehner’s hand. On Aug. 27 a group called Faith2Action held a rally outside his offices in Ohio pledging to start calling the health law “Boehnercare” if he allows funding to continue.

“I’m beginning to think Boehner’s thinking, if they don’t want me to be the speaker I don’t care, but I’m not going to shut down the government and I’m not going to default on the nation’s debts,” said Bill Hoagland, a former Republican staff director of the Senate Budget Committee.

The Obama administration has said it would veto legislation to withhold money for carrying out the health-care law, raising the possibility of a government shutdown if Republicans attached it to a measure funding the government.

Short-Term Bill

Eighty House Republicans -- less than half of the caucus -- sent an Aug. 21 letter to Boehner urging him to defund the health-care law as part of a short-term bill to fund government operations. In the Senate, Cruz and Lee have 13 signatures -- also less than half of the chamber’s Republicans -- on a similar letter.

“You effectively can’t defund the ACA,” said Joseph Antos, a health analyst at the American Enterprise Institute, a Washington-based policy group that supports free markets. For instance, “a lot of the activity involves contracts that have already been let with private parties,” he said.

Even some who support the defunding effort say it’s mostly political. On Aug. 22, Republican Senator Rand Paul of Kentucky told CNN that “it’s a dumb idea to shut down the government.” That is a means of “leverage” in fiscal negotiations, he said.

The public also opposes defunding, according to a Kaiser Family Foundation poll released yesterday. The poll found that while 42 percent of Americans oppose the law, 57 percent don’t want to cut off funding, including 34 percent of Republicans.

Individual Mandate

Republicans maintain that the law’s individual mandate to purchase insurance will pose an economic hardship to lower-income individuals.

Meanwhile, the Obama administration is “not interested at all in delaying” the health-care law as a way to get a budget deal with Congress, White House Budget Director Sylvia Burwell said in an Aug. 23 interview on Bloomberg Television’s “Political Capital with Al Hunt.”

Hoagland, now a senior vice president at the Bipartisan Policy Center in Washington, said that getting a delay is a “long shot, but that will be the strategy the Republicans will attempt.”

It’s a new tactic with the same objective, said Tony Carrk, director of health care at the Center for American Progress Action Fund. “It’s purely a political argument they’re making to try to repeal the law,” he said.

Debt Limit

House congressional aides say no decision has been made about whether to push for a delay as part of short-term government funding or in talks over raising the nation’s borrowing limit, which Treasury forecasts will be reached in mid-October. To minimize the conflict, Republicans including Price insist a delay would be equivalent to defunding.

Senior Senate aides say Republicans will probably request a delay of the entire law, while preparing to accept something less than that. For example, they cited a potential delay in the individual mandate and some of the subsidies that will flow to individuals.

A delay of the entire law would be both legislatively and practically difficult to achieve. It has many popular parts, including barring insurance companies from refusing coverage based on pre-existing conditions and permitting adult children to stay on their parents’ insurance plan.

Further, many of the law’s participating programs are on funding autopilot, so Congress would have to cast at least 60 separate votes affecting such programs as Medicaid, according to one Senate Republican estimate.

‘Easy Ways’

“The easy ways to resolve this to protect the people in our districts from this are gone,” said Representative James Lankford, an Oklahoma Republican and chairman of the House Republican Policy Committee.

Yesterday, the administration pushed back the signing of final agreements with insurance plans to be sold on federal health insurance exchanges starting on Oct. 1.

Senate Minority Leader Mitch McConnell of Kentucky sent a letter this month to the Centers for Medicare and Medicaid Services saying the administration shouldn’t open the health exchanges when the government is missing testing deadlines and can’t guarantee the security of personal and financial data.

“The public’s going to see very clearly that the rates are shockingly higher than anyone anticipated,” said Representative Michael Burgess, a Texas Republican.

Republican claims that individuals will face higher health-care rates are “factually unsupported,” said Hank Aaron, a health analyst at the Brookings Institution in Washington.

Health-Care Premiums

Premiums for the “silver” health-care plan, which would cover about 70 percent of a policyholder’s costs, will average about $321 a month in the 11 states that are building their own exchanges and have announced prices, said a July report by the Department of Health and Human Services.

That’s about 18 percent less than anticipated, the agency said, based on an estimate it derived from Congressional Budget Office data from March 2012. The premiums don’t include any discount from subsidies, which will be available to anyone earning less than four times the poverty level, or about $94,000 a year for a family of four.

“If they have modest incomes, they are going to be eligible for subsidies,” Aaron said. The more information that is spread about the program, the more Americans will join the insurance pool, further lowering rates, he said.

To contact the reporter on this story: Heidi Przybyla in Washington at hprzybyla@bloomberg.net

To contact the editor responsible for this story: Jodi Schneider at Jschneider50@bloomberg.net

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