Health Reform Votes

HOUSE|SENATE

112th congress, vote #285; House of Representatives #1213

Repealing Funding for State Health Benefit Exchanges

Official Title: To repeal mandatory funding provided to States in the Patient Protection and Affordable Care Act to establish American Health Benefit Exchanges.

HR 1213: Repealing Funding for State Health Benefit Exchanges
Passed House May 3, 2011, 238-183 (11 abstentions).

Synopsis: This bill set out to repeal the mandatory funding that the Patient Protection and Affordable Care Act (PPACA) promises to the states to help them set up American Health Benefit Exchanges.

These Exchanges are meant to serve as one-stop marketplaces where individuals and small businesses will find it easier and more affordable to purchase insurance. Consumers will no longer have to choose from a crazy quilt of insurance plans.

Beginning in 2014, Exchanges in each state are expected to offer consumers a choice of health plans that provide a uniform package of "essential benefits." The Exchanges also will offer standardized information about premiums, co-pays, deductibles and coverage that will make comparisons easier.

Initially, the Exchanges will be open to smaller employers with up to 100 employees as well as individuals purchasing insurance on their own. By purchasing insurance in an Exchanges, they will automatically become part of a larger pool of buyers, and so enjoy the lower premiums that insurers offer to large companies. In addition, when purchasing insurance through the Exchanges, low and middle-income individuals will be eligible for federal subsidies. A few years after the Exchanges are established, states would have the option of opening them to larger employers.

Why supporters pushed for this bill

It would reduce federal spending by $14 billion over 10 years.
Many saw this spending on Exchanges as a "blank check." "The Administration is already using this unlimited slush fund to seduce states into collaborating in the implementation of Obamacare and has hinted at tapping it to bail out exploding state Medicaid budgets," wrote Matt Kibbe, president and CEO of FreedomWorks, in a letter to supporters.
Federal funding for the Exchanges represents a "dangerous, irresponsible and unconstitutional delegation of money and power to the Executive Branch" Kibbe added. "Under our Constitution, only Congress has the power of the purse. To formally delegate the President the power to appropriate funds from the Treasury without stint or limit breaches the separation of powers."

Why opponents tried to stop the bill

They argued that many states would not be able to get Exchanges up and running without federal support.
Opponents pointed to a Congressional Budget Office study which said that 85 percent of the total $14 billion in cuts would come at the expense of low and moderate-income Americans.
The CBO study estimated that without reliable funding for the Exchanges, by 2015, 2 million fewer people would be enrolled in insurance through the Exchanges, and 500,000 more Americans would be uninsured.
Opponents also noted that the funding to the states is not open-ended. The actual money provided to states is estimated to be $1.9 billion between 2012 and 2015. The ACA prohibits any of these funds from being used by states beyond January 1, 2015, when the exchanges must become self sustaining.