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Minimal actual impact of budget fuss on PPACA
Old 09-19-2013, 03:00 PM   #1
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Minimal actual impact of budget fuss on PPACA

Some folks have been worried about medical insurance planning, particularly with the new PPACA insurance exchanges scheduled to come on-line on October 1, roughly when the US Federal budget expires and the debt ceiling is reached. I know I have been, as I am one of those retirees without a retirement health care plan and too young for Medicare.

It turns out that nothing in the budgetary fuss, no matter which way it goes (Defund It!/Shut down the Gummint!/Just Keep Trucking On) will actually have much effect. Sen. Tom Coburn (R-Okla) asked the Congressional Research Service to look into this. The results are reassuring for those of us that need insurance.

First, with or without funding, the law remains in place. Companies still have to demonstrate fraudulent intent before they can rescind a policy. New policies have to meet all the new requirements. Guaranteed issue remains in place.

Second, a 'government shutdown' doesn't really shut down the government. The law, policy, and operational planning assume that a government shutdown is temporary, and Federal agencies have contingency plans in place. The armed forces do not discharge everyone, the Border Patrol keeps patrolling, and Social Security and Medicare still have their trust funds. "For Sale" signs do not appear on the Washington Mall.

“The HHS shutdown contingency plan that was prepared in anticipation of a possible government shutdown in FY 2012 indicated that ACA implementation activities at CMS would continue because of the mandatory funding provided in the law,” the CRS report says. The only real way to strip the law of these mandatory funds would be to repeal the full law.

Article 1 Section 9 of the US Constitution states "No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law." Federal employees, for example, can't be paid if appropriations in the first place have not been enacted. Now, Congress could make contracts or other obligations even without funds, but there is a law that generally prevents this called the Antideficiency Act. The law does carve out exceptions for various emergency services. This is the law that sharply limits government activity during a budget kerfluffle.

The ACA implementation can continue during the lapse in annual appropriations and temporary shutdown. First, the federal government can rely on funding other than annual discretionary funds available, along with mandatory funds (funds allocated and controlled outside annual appropriations act, such as those allocated by the PPACA law). Second, the agencies can continue to operate on certain activities that fall under exceptions to the Antideficiency Act.

You can read more about the details here, in the report prepared by the Congressional Research Service for Senator Coburn.

http://www.coburn.senate.gov/public/...4-9d27e2b690ac

Note that this discusses the current law of the land, as passed by Congress, and how the government can operate under this law. Discussions about how "that ain't right" and "what they should have done" are probably inviting moderator stompage. I wanted to present this information to reassure those of us who are facing perceived uncertainty in the face of all the assorted political posturing and general bloviating going on.
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Old 09-19-2013, 04:21 PM   #2
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+1


Thank you for taking the time to post this : )
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Old 09-19-2013, 05:01 PM   #3
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The polarization of both sides of the aisle is despicable. They are all a bunch of frickin' idiots.
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Old 09-19-2013, 05:40 PM   #4
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Thanks for posting, very good information.
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Old 09-19-2013, 07:49 PM   #5
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Thanks for posting, very good information.

+1

Very helpful info.
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Old 09-19-2013, 08:44 PM   #6
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Interesting OP. Thanks.

I find Coburn to be one of the more interesting (and tolerable) members of the Senate. An M.D., a Republican yet a friend of the President, speaks regularly in opposition to policies he does not support but is always civil and thoughtful in his comments. Too bad the press is drawn to the more fiery Senators so often.

Random thought...what turns would the debate take if the federal exchanges actually opened a few days early? Or a few days late? So far as I know, there is nothing in the PPACA that actually specifies the October 1 date.
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Old 09-19-2013, 09:22 PM   #7
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+1


Thank you for taking the time to post this : )
+1

I've added the CRS paper to the FAQ section.

AFAIK Oct 1 is just a target date and Jan 1 2014 is a legislative mandate. Having experienced my share and then some of project management and new systems development & implementation, the Oct date is more important. Time is needed to work out the bugs, let operators make some mistakes and still have time for Jan 1 operation.
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Old 09-20-2013, 06:31 AM   #8
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+1

I've added the CRS paper to the FAQ section.

AFAIK Oct 1 is just a target date and Jan 1 2014 is a legislative mandate. Having experienced my share and then some of project management and new systems development & implementation, the Oct date is more important. Time is needed to work out the bugs, let operators make some mistakes and still have time for Jan 1 operation.
These are pretty complex IT systems. It would be a real surprise if they work well out of the box. They will need the first months to work out the kinks, and then some. Nice to know that a shutdown won't necessarily add a lot more trouble to the startup.

We really need to do something about our health care system. If the PPACA gets completely shutdown we could be set back decades. As long as it moves forward for the most part (even if some parts get delayed in some face saving compromise to solve the funding impasse) we can hope that eventually the combatants will see reason and work toward fixing the weak parts rather than fighting for political points.
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Old 09-20-2013, 10:07 AM   #9
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There's talk that the House Republicans would offer to raise the debt ceiling for a year in exchange for a 1 year delay in the ACA.

Has there ever been any law subject to these kinds of challenges? All the legal challenges and the repeal attempts. Then there is going to be some PR effort to discourage people from complying, buying insurance as required.

I don't think you can put this only as a pox on both their houses.
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Old 09-20-2013, 10:49 AM   #10
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I would trade a year delay on ACA to permanently change the law to eliminate the concept of a debt ceiling. We have seen in the last few years that the law presents a substantial risk and no benefit other than to empower parties willing to use it to play global economic collapse chicken. It never seemed a big deal back in the days both parties used it as an opportunity to talk up their issues with no possibility to let it trigger a default. But now our FIRE status is put at risk.
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Old 09-20-2013, 11:16 AM   #11
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Well Obama has said he won't negotiate on the debt ceiling, which has never been subject to bartering.

If Paquette is right that the Republicans can't stop the ACA short of full repeal, then Obama would be giving away the store for nothing by agreeing to it.

Those opposed to the ACA is trying to portray it as a "mess" with people paying way more or being dropped from employer coverage. But the 40 votes to repeal in the House suggests politics are at play, not some objections on the merit.
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Old 09-20-2013, 11:26 AM   #12
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Let's keep the thread on PPACA.
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Old 09-20-2013, 11:37 AM   #13
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Well Obama has said he won't negotiate on the debt ceiling, which has never been subject to bartering.
Remember the bartering in 2011? That happened.

The fight over this law will continue for years. Every time it comes up for funding, every time there's a chance to amend it or it's key provisions via riders on other legislation, every time there's a change in the balance of control of the House, Senate, Executive Branch, or a new appointment to the Supreme Court.

If the law were popular this wouldn't be the case, but it is not popular. Proponents of the law have stopped claiming many of the things they used to claim (e.g. that we'll "be able to keep our health insurance if we like it", or that it will save the average family $2500, etc). Those who think that the law was passed, the matter is settled, and everyone should just shut up and take it are delusional and ignorant of the ways of democracy. And there's a lesson here for everyone about the need for a true mandate and finding consensus before making sweeping changes. There are lessons about the likely result of being a bit too clever in achieving legislative "success" by any means 'necessary'.

Checks and balances are a good thing.
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Old 09-20-2013, 11:47 AM   #14
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If the law were popular this wouldn't be the case, but it is not popular.
There is so much disinformation and a lack of good information being spread, many people have no idea what they even have to gain, even the ones who may benefit greatly, like many early retiree wannabees.

Once it is in and people are getting subsidies or the otherwise uninsured are now qualifying for insurance, it will be very, very hard to undo, just like taking away Social Security or Medicare benefits is now.
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Old 09-20-2013, 12:00 PM   #15
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There is so much disinformation and a lack of good information being spread, many people have no idea what they even have to gain, even the ones who may benefit greatly, like many early retiree wannabees.
The way this is supposed to work is that the proponents of an idea are expected to explain it to people and gain their support. That's hard, takes time, but results in permanent change. Doing things "from the top down" tends to rub people the wrong way. That's what we're seeing.

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Once it is in and people are getting subsidies or the otherwise uninsured are now qualifying for insurance, it will be very, very hard to undo, just like taking away Social Security or Medicare benefits is now.
I'm afraid you are likely right about this. Frankly, it is the reason that this fight is so aggressive right now--from both sides. Those who favor the law want to "lock in" the gains by getting folks used to the "free money" and those opposed to the law are fully aware of the same dynamic. Objectively and non-politically, delaying implementation a year would clearly allow a lot of the evident kinks to be addressed, but proponents of the changes do not want to delay this "locking in" effect.
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Old 09-20-2013, 05:01 PM   #16
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Thanks to the OP and those who were careful to keep politics to a minimum

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