There’s an interesting split developing between foes of ObamaCare right now. On the one hand, there are folks who want to work within the boundaries of the Affordable Care Act, at least for now, and attempt to pass legislative tweaks that might improve the law. On the other hand are those who will settle for nothing less than full repeal.
You can see this split today in the back and forth over the Helping Sick Americans Now Act. The bill, which is scheduled for a House vote today, would take about $4 billion from ObamaCare’s prevention fund and put it toward the law’s high risk pools—the Preexisting Condition Insurance Plan (PCIP).
There are a couple of goals here. One is to put money towards the law’s high-risk pools, which earlier this year were shuttered to new entrants due to a lack of funding. Republicans are generally more sympathetic to the concept of publicly subsidized high-risk pools than to other types of health reforms, although it’s not clear that many are particularly big fans of the specific high-risk pools built into ObamaCare. (A number of Republican governors, for example, declined to participate in the program, deeming it a potential budget liability.)
Another is to take money away from the prevention fund, which is widely seen as a slush fund for funneling money to liberal causes—as well for potentially funding the implementation of the law’s health insurance exchanges. So the argument for the bill is that it would shift money from something Republicans don’t like to something they do like—or at least dislike less.
And in the process, some Republicans think they can perhaps embarrass President Obama by asking him to approve a funding shift that would help provide health insurance to as many as 40,000 additional people. If he says no, then what does that say about his commitment to helping people get health insurance? GOP members of the House Energy and Commerce Committee have already written a letter to the White House to this effect.
The bill’s opponents basically argue that it does little more than rearrange deck chairs on a sinking ship. “We’re shifting money from one part of Obamacare we don’t support to another part of Obamacare we don’t support,” Rep. Justin Amash (R-Michigan) said today, according to NRO's Katrina Trinko. “That’s a non-starter for me.”
Conservative critics of the bill are worried that it will allow Obamacare’s liberal backers to accuse them of wanting to spend more on the part of Obamacare they like. And sure enough, earlier today ThinkProgress ran an item titled “Republicans to back bill expanding ObamaCare program.”
One question here is how much this sort of small-ball tweak really matters in the larger scheme of things. But what most Obamacare critics seem to be asking is whether or not it’s worth the hypocrisy charges, and the inter-coalition squabbling, to try to repurpose the money to the high-risk pools. A concern is that although the high risk pools may be more amenable to the GOP sensibility than most of the rest of the law, they are still deeply flawed. Per-beneficiary costs turned out to be much higher in the program than expected—so high that despite enrollment being far lower than expected (about 100,000 versus the 300,000 initially projected) the program had to close entry early.
It’s maybe not the best signal for the full-repeal crowd. And that’s what worries some of them. “Our first vote on Obamacare,” Indiana Rep. Tim Huelskamp told NRO, “will be an expansion of a failed part of the program that’s come in drastically over cost.”