The Obama administration’s ongoing difficulty in implementing the Affordable Care Act, also known as Obamacare, is forcing the president to chip away at parts of the law, rankling allies and providing critics ammunition.
The money needed for implementation continues to rise. HHS announced on Wednesday that it would need more than double the funding it estimated last year to get health insurance exchanges, the primary means of delivering insurance under the law, up and running.
The agency is looking for an additional $1.5 billion to finance federally run exchanges in states that decline to establish exchanges of their own.
However, Congress is unlikely to authorize additional funding for a law that is already expected to add trillions to the national debt. Additionally, House Republicans have realized that their ability to deny funding for implementation is a powerful means to undermine the law.
"The number one goal is to repeal the law," a House Republican leadership aide told the Washington Free Beacon. "But after voting on it however many times we did last Congress, we’re seeing there are strategic ways to go about it, through the appropriations process and the power of the purse strings."
With virtually no prospect for additional congressional authorizations for implementation, HHS has signaled it may draw money from the law’s Prevention and Public Health Fund to finance the effort.
That move drew criticism even from supporters of the law.
"Robbing prevention when we know these efforts can reduce chronic disease and lower health care costs goes against the very mission of health care reform," said Sen. Tom Harkin (D., Iowa) in a statement.
Divisions within Democratic ranks could prove troublesome for the administration. If it falls short of the funding needed to effectively implement the law, the results could be disastrous.
Ellen Murray, the agency’s assistant secretary for Financial Resources, declined to say Wednesday what the consequences of a financial shortfall would be. But even Obamacare’s most strident supporters have warned of the consequences of faulty implementation.
The law is "so complicated, and if it isn't done right the first time, it will just simply get worse," Sen. Jay Rockefeller (D., W.Va.), one of the law’s chief architects, warned on Tuesday.
Rockefeller called Obamacare "the most complex piece of legislation ever passed by the United States Congress."
For Republicans looking to repeal the law, Obamacare’s bureaucratic hurdles could prove an effective means of combatting it.
"Republicans don't need to start with a full replacement bill," said GOP strategist Rick Wilson. "They just have to let the beast sink into the tar pit."
"The whole shambolic mess had so many dependencies, rosy scenarios, and upside biases (politically, fiscally and structurally) that when one element falls prey to reality, the whole thing can go off the rails," he said.
Additionally, Republicans have found the hurdles to Obamacare’s implementation to be an effective messaging tool in combatting the measure.
House Republican Whip Kevin McCarthy (Calif.) told reporters on Thursday that the law is "going to come back and be the number one issue in the next election," due in part to the ongoing problems in getting the whole measure up and running.
Asked about the HHS plan to drain the prevention fund to pay for implementation, McCarthy said, "[the law] is hurting health care … and it’s making the system worse. That’s why we’ll continue highlighting those points."
McCarthy said House Republicans are going to create a working group to emphasize the areas in which Obamacare has sacrificed measures designed to improve patient care in order to ease its implementation costs.
Another House Republican leadership aide also cited HHS’s cancelation of a fund designed to insure Americans with pre-existing conditions until Obamacare’s exchanges are set up. HHS cited budgetary constraints in doing away with the fund.
"Rather than help sick people with pre-existing conditions, President Obama is spending money on more bureaucracy and programs that will fail regardless of how much money is thrown at them," the aide said.
HHS Secretary Kathleen Sebelius has blamed uncooperative state governments for the ongoing problems in implementing the law. But experts say the administration never fully accounted for its costs.
"It was not enough for them to make the argument for more coverage—they had to also insist that creating a massive new entitlement and expanding the Great Society would somehow result in deficit savings," said Ben Domenech, a health policy expert with the Heartland Institute.
"No one but the White House and its most loyal backers believed this at the time, and now every week brings new proof that Obamacare simply won't work the way they promised and will cost a lot more along the way," Domenech said.