CONGRESSWOMAN ELISE STEFANIK
On Friday, September 20, 2013, the House will consider H.R. 2682, a bill to prohibit funding of the Patient Protection and Affordable Care Act, under a rule. H.R. 2682 was introduced on July 11, 2013 by Representative Tom Graves (R-GA) and has which has 148 cosponsors.
H.R. 2682 prohibits the funding of any provision of the Patient Protection and Affordable Care Act or title I and subtitle B of title II of the Health Care and Education Reconciliation Act of 2010. Finally, it repeals any benefit and/or entitlement included in each of the above mentioned Acts and rescinds any and all unobligated balances.
On March 23, 2010, the Democratic House and Senate passed, and the President signed into law, the Patient Protection and Affordable Care Act. The legislation passed by a vote of 219-212 (see Roll Call #165). Later on March 25, 2010, the Democratic House and Senate passed, and the President signed into law, H.R. 4872, the Health Care and Education Reconciliation Act of 2010, which passed by a vote of 220-207 (see Roll Call #194). Among other things, the law requires that most individuals obtain health insurance or pay a penalty tax; requires employers with 50 or more full time employees to provide approved health care coverage or pay a penalty tax; establishes insurance exchanges through which individuals and families will receive taxpayer-funded premium subsidies; expands Medicaid; cuts Medicare by $716 billion; imposes 21 additional taxes on health insurance plans, medical devices, businesses, families, and individuals at a cost of $1.1 trillion. CBO’s February 2013 coverage estimate puts the total cost of coverage at $1.88 trillion up significantly from its initial 2010 estimate of $940 billion.
According to CRS,
“[A]CA implementation affects not only direct spending and revenues but also discretionary spending, which is subject to the annual appropriations process. The law includes numerous discretionary spending provisions that authorize the appropriation of funds to implement grant programs and other activities. These provisions are of two kinds:
Authorizations of appropriations for new discretionary grant and other programs created by ACA.
Authorizations of appropriations for existing programs, primarily ones authorized under the Public Health Service Act (PHSA). In most instances, the appropriation authorizations for these established programs expired prior to their reauthorization by ACA. However, almost all of them continued to receive an annual appropriation.
Many of the ACA discretionary spending provisions authorize annual appropriations of specified amounts for one or more fiscal years to carry out the program or activity. Other provisions authorize the appropriation of specified amounts for FY2010 or FY2011 and unspecified amounts—such sums as may be necessary, or SSAN—for later years. A few provisions authorize multi-year appropriations, available for obligation for a period in excess of one fiscal year (e.g., for the period FY2011 through FY2014). Numerous other provisions simply authorize the appropriation of SSAN, in a few cases without specifying any fiscal years.
The Congressional Budget Office (CBO) estimated that ACA's discretionary spending provisions, if fully funded by future appropriations acts, would result in appropriations of almost $100 billion over the period FY2012-FY2021.11 However, much of that funding—about $85 billion—would be for three programs that were in existence prior to, and whose funding was reauthorized by, ACA; namely, the National Health Service Corps, the federal health centers program, and the Indian Health Service (IHS).
Most, though not all, of the existing grant programs that were reauthorized under ACA received a discretionary appropriation for FY2011, FY2012, and FY2013, as well as a FY2014 request for continued funding. In contrast, few of the new grant programs authorized under ACA have received annual discretionary appropriations.12 However, several of the new programs have received mandatory funds from ACA's Prevention and Public Health Fund.”
CRS goes on to state,
“[The ACA] included numerous mandatory appropriations that provide billions of dollars to fund new and existing grant programs and activities within HHS.
Of particular note, ACA established two multi-billion dollar funds that are providing amounts to several of the discretionary grant programs authorized (or reauthorized) under ACA:
The Community Health Center Fund (CHCF), to which ACA provided a total of $11 billion in annual appropriations over a five-year period (i.e., FY2011-FY2015), is helping support the federal health centers program and the National Health Service Corps (NHSC). While CHCF funding may have been intended to supplement annual discretionary appropriations for health centers and the NHSC program, the funds have partially supplanted discretionary health center appropriations and have become the sole source of funding for the NHSC program, which received no discretionary funds in FY2012 or FY2013.
The Prevention and Public Health Fund (PPHF), for which ACA provided a permanent annual appropriation, is intended to fund prevention, wellness, and other public health-related programs and activities authorized under the PHSA. PPHF funds have been used to support several new discretionary grant programs authorized by ACA. In addition, PPHF funds have supplemented, and in some cases supplanted, annual discretionary appropriations for a number of established programs, including ones that were reauthorized by ACA.”
 The Health Care and Education Reconciliation Act of 2010 amended certain provisions of PPACA through the reconciliation process.
 See http://www.crs.gov/pdfloader/R41390, at 2-4.
 Id at 6.
A CBO estimate is not available at this time.
For questions or further information contact the Conference Policy Shop at 5-5107.