Any delays in instituting the law can — and likely will — be magnified into a media narrative about the administration’s broken promises; but it shouldn’t bare the brunt of the blame. The orchestrated Republican effort to deny ACA’s health care benefits is largely responsible. The GOP may have failed in its effort to repeal Obamacare in Congress, lost at the Supreme Court in June and the ballot box in November, but the party isn’t backing down from trying to dismantle or delay the law.
Republicans in 26 states are refusing to implement exchanges that would allow millions of uninsured residents to obtain private coverage and many aren’t lifting a finger to expand Medicaid eligibility for the lowest income Americans. The intransigence is forcing the federal government to do more just as Congress is appropriating less.
Republicans have denied additional funding requests for ACA implementation in FY 2013 and FY 2012, leaving the agency running at pre-ACA levels. HHS lost billions from sequestration, including $13 million in cuts from the Consumer Operated and Oriented Plan Program (CO-OPS), $51 million from the Prevention and Public Health Fund, and $44 million cut from the Affordable Insurance Exchange Grants program. Congress voted to repeal the law at least 33 times, successfully taken money out of prevention, rolled back reporting requirements, and consistently proposed offsetting additional spending by pealing back various sections of the law. Last week, the debate over the budget in the Senate suggested that the law’s excise tax on medical devises may be on the chopping block.
HHS cites “operational challenges” as the reason for the delay in implementing SHOP, but insists that it’s on track to open the exchanges by 2014. Meeting that deadline alone will signify that the law is on track to meeting its lofty promises and serve a deep blow to the opponents who are constantly seeking to undermine them.
In 2014, employers may choose one plan from a SHOP exchange for their employees. By 2015, however, the employees can choose from a range of plans. State-run exchanges will be able to offer more choices to employees beginning in 2014.