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Health Law Funding: GOP Sticking Point In Spending Bill

The Washington Post’s Amy Goldstein joins KHN’s Mary Agnes Carey and the Kaiser Family Foundation’s Jackie Judd to talk about health developments on the Hill. This week: Some House and Senate Republicans have said they will vote against a three-week funding measure for the federal government because it does not take steps to stop funding for implementation of the health care law. Separately, health care is surfacing as a key issue among potential GOP presidential candidates.

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JACKIE JUDD: Good day. I am Jackie Judd. This is Health on the Hill. Congress is once again debating government funding. Will there be another stopgap measure or a long-term spending bill? Some conservative Republicans in the Senate and House oppose the stopgap measure, even if it means a government shutdown. Congressman Steve King told Politico Pro that unless the measure blocks funds for the health care reform law, he will vote no.

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JACKIE JUDD: The politics of health reform on the Hill and on the presidential campaign is our topic for today. Here, as always, is Mary Agnes Carey, senior correspondent for Kaiser Health News, and we are happy to welcome to Health on the Hill, Amy Goldstein of The Washington Post. Welcome, Amy.


JACKIE JUDD: Mary Agnes, first set the stage for us, the current continuing resolution expires this coming Friday, so where does Congress stand right now?

MARY AGNES CAREY: We gave another stopgap bill in the works. It would last through April eighth. It does not include any of the health care defunding amendments and that is what Congressman King and some other Republican conservatives in the House are upset about. And many may join him and say they are going to vote against this newest stopgap CR because it does not have the defunding language for the health law in it.

JACKIE JUDD: Amy, how much of a threat is Steve King and his conservative colleagues to this measure?

AMY GOLDSTEIN: Well, rhetorically it’s a threat, because it’s one more in what has become a drumbeat of criticism of the law. But, practically, defunding the law is hard to do, at least defunding it in a major way is hard to do, because when the law was enacted last year, it included in it most of the appropriations needed to carry out the law.

So, in practical terms, basically the only thing that Republicans could do is to defund the agencies that have to work to carry out the law, which they could do theoretically, but they have the majority of one chamber of Congress and they don’t have the White House, so the odds that that will happen are not nonexistent but they are pretty slim.

JACKIE JUDD: So, I think you called it a drumbeat, why continue the drumbeat? Is it for the conservative folks back at home, members of the tea party, and if so what do the congressmen on the Hill get out of that strategy?

AMY GOLDSTEIN: Well, it’s partly for the conservative base of the Republican Party, but I think it’s also an effort to continue to de-legitimatize this law, in the minds of the American people more broadly. I think it’s too early to have some sense of how successful that effort will be, but I think that is what the goal is.

JACKIE JUDD: And all of this, of course, is already being infused into some of the potential presidential candidates who are out in New Hampshire, Tim Pawlenty, the former governor of Minnesota, was just there a few days ago. What is someone like him saying about the health care reform law at this moment?

MARY AGNES CAREY: What he feels is that the law relies too much on the current system. It takes government funding for the health insurance exchanges and the subsidies to give people coverage under the current system, but doesn’t do enough to control costs. He is a big fan of a limited amount of money for a particular treatment.

If you go somewhere that costs more and it’s inefficient, it should be out of your pocket, not out of your employer’s pocket or out of the government’s pocket. He was asked about this in an interview on National Public Radio and the interviewer kept saying doesn’t the health law do exactly what you want it to do? He says it’s got some demonstration programs to try to link payment to quality, but it’s not broad enough of a measure, and he thinks that health reform should focus more on that.

JACKIE JUDD: Take a broader look for us, Amy, at the potential candidates on the Republican side, of course, how are they tackling this? What are some of the grand themes that we are hearing so far?

AMY GOLDSTEIN: Well, in the case of former Governor Pawlenty, he is positioning himself as the prime critic of the law. He had a wonderful phrase in his speech the other week in which he said that, he analogized that the law was like being a drug dealer. He said that it is going to briefly give people a free sample, and then hook them on government programs.

So, he has gone way out of his way to say that he was, as governor, one of the prime opponents of this law. And I think in the broader context, one can view the opposition on Capitol Hill, the opposition in state houses around the country is an increasing number of Governors now are Republican as a setup for the 2012 campaign.

The Republicans are giving every indication that they are going to use this health care law as a chief weapon to try to criticize the Democrats’ domestic policies. That is a smoother thing to do for some potential candidates than for others.

JACKIE JUDD: Like Romney.

AMY GOLDSTEIN: Like Mitt Romney, the former governor of Massachusetts, who is in a particularly awkward position, because it was when he was governor that Massachusetts adopted its health care law, which was in essence a role model for much of what the federal government has now followed and done.

So, he has been trying to cut a very fine line in which he is saying that, he is not walking back from the Massachusetts law, though lately he has been saying that they could have done some things better in his own state.

JACKIE JUDD: And I think, wasn’t Pawlenty asked in the New Hampshire appearance what did he think of Romney and Pawlenty basically took a pass?

MARY AGNES CAREY: They are not going to go there. He said to the press, you guys always bring this up. You want me to criticize Massachusetts. There is tension between me and Mitt and I am not going to talk about that.

JACKIE JUDD: A final question to you, Amy, you were one of several Washington Post reporters who about a year ago wrote and released a book about the health care reform law. A year out, we are coming up on the first anniversary of President Obama signing it, could you have predicted that we would be where we are today?

AMY GOLDSTEIN: Partly yes and partly no. The partly no is that if Republicans had not taken back the majority and one-half of Congress, we would not be having quite as lively and acrimonious, a political debate now about whether the law was the right thing to do. So, that is the “no.”

The “yes” is that one of the things that my colleagues and I said in the book, which is called Landmark, is that it would take a long time, even though the law is 2,000 pages and has lots of detail in it, for how it was really going to work on the ground to become clear.

It was going to depend a lot on regulations at HHS, it’s still in the process of writing and unveiling, and it is particularly going to depend on the responses of states that have to make some big decisions, particularly about the new insurance market places called “exchanges” that are going to take affect in 2014. And those states are still making hard calls about what they want their exchanges to look like, so to the extent that a year ago we predicted that it would take quite a while for the law to kind of become a tangible thing, that is what is happening now.

JACKIE JUDD: Maybe even an understatement.

AMY GOLDSTEIN: Maybe even.

JACKIE JUDD: [Laughs] Thank you so much. We are happy to have you here today, Amy Goldstein, and of course, Mary Agnes Carey of Kaiser Health News. Thank you both.

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