How The Budget Deal Could Threaten Obamacare

An angry John Boehner (R-OH) lashed out at conservative groups who opposed the budget deal.  The deal strengthens his hand with his caucus and in negotiations over changes to Obamacare.  [Credit: Washington Post]

An angry John Boehn­er (R‑OH) lashed out at con­ser­v­a­tive groups who opposed the bud­get deal. The deal strength­ens his hand with his cau­cus and in nego­ti­a­tions over changes to Oba­macare. [Cred­it: Wash­ing­ton Post]

“Frankly, I think they’re mis­lead­ing their fol­low­ers. I think they’re push­ing our mem­bers in places where they don’t want to be. And frankly, I just think that they’ve lost all cred­i­bil­i­ty.” – House Speak­er John Boehn­er (R‑OH), com­ment­ing on oppo­si­tion by con­ser­v­a­tive groups to the bud­get deal.

Last week’s over­whelm­ing House vote to rat­i­fy a mod­est bud­get agree­ment has been var­i­ous­ly depict­ed as a defeat for the Tea Par­ty, a rare instance of bipar­ti­san­ship, and a moment of ratio­nal­i­ty in an oth­er­wise chaot­ic and dys­func­tion­al bud­get process. It is all of those things and some­thing more: a new threat to the already trou­bled imple­men­ta­tion of Obamacare.

The Sen­ate is sched­uled to vote tomor­row on invok­ing clo­ture on the agree­ment. Should the Sen­ate fol­low the House­’s lead, the like­li­hood of anoth­er gov­ern­ment shut­down on Jan­u­ary 15 will become infin­i­tes­i­mal. It would also serve as a rebuke to out­side groups on the Left and Right. House Democ­rats backed the deal, despite crit­i­cisms from labor unions that it requires fed­er­al work­ers to con­tribute more to their pen­sions and allows unem­ploy­ment ben­e­fits for an esti­mat­ed 1.3 mil­lion Amer­i­cans to expire lat­er this month. House Repub­li­cans ignored their Tea Par­ty wing, which argued that the deal marked a retreat from the dis­ci­pline of across-the-board cuts.

The con­ser­v­a­tive argu­ment in favor of seques­tra­tion is a curi­ous one. Auto­mat­ic cuts were con­ceived in the bud­get deal of 2011, a deal that many con­ser­v­a­tives fault­ed as too timid. The mea­sure called for the cre­ation of a spe­cial com­mit­tee to write a bill to reduce fed­er­al bor­row­ing by $1.5 tril­lion over a decade. If that com­mit­tee failed, which it inevitably did, auto­mat­ic cuts total­ing $1.2 tril­lion would take effect over a series of years. Those cuts would large­ly spare enti­tle­ment pro­grams, which pose the most severe threats to the government’s fis­cal health, slash­ing mil­i­tary and domes­tic spend­ing instead.

Con­ser­v­a­tives argued that these cuts were Pres­i­dent Obama’s idea which, in their minds, is the cru­elest insult imag­in­able. But in the wake of the President’s re-elec­tion, con­ser­v­a­tive think­ing abrupt­ly changed. They embraced the President’s seques­tra­tion pro­pos­al they once loathed, treat­ing it as though it were their great­est achieve­ment. Sequester, instead of the con­se­quence of fail­ure, became the goal. When it came to reduc­ing deficits, con­ser­v­a­tives sud­den­ly pre­ferred mind­less across-the-board cuts to rea­soned pol­i­cy changes.

Their beef with this most recent bud­get deal does have some mer­it. They point out that, while the spend­ing increas­es are imme­di­ate, the off­set­ting sav­ings will take years to mate­ri­al­ize. The chart below [click on it to enlarge] illus­trates their point.

Chart of spending and savings

Under the bud­get deal, new fed­er­al spend­ing will amount to $63.2 bil­lion, but it will be off­set by a total of $85 bil­lion in deficit reduc­tion over a ten-year peri­od, mean­ing that it will reduce the deficit by about $22 bil­lion.  As con­ser­v­a­tive crit­ics have not­ed, the spend­ing increas­es will be imme­di­ate, while the sav­ings will take a decade to mate­ri­al­ize. The deal allows fed­er­al spend­ing to increase by $63.2 bil­lion over this year and next. Only $6.5 bil­lion of that addi­tion­al spend­ing will be off­set dur­ing that time. Advo­cates of the deal argue that sav­ings mount over the years, and the chart cor­rob­o­rates that. Sav­ings from 2016–2021 will amount to $31.2 bil­lion. But even after eight years, the fed­er­al gov­ern­ment will remain in a hole: hav­ing spent $63.2 bil­lion in just two years, it will still have have recov­ered only $37.7 bil­lion after eight. The bulk of the sav­ings – and the entire $22 bil­lion in deficit reduc­tion — won’t be real­ized until 2022 and 2023. So it is fair to say that the deal allows the gov­ern­ment to spend imme­di­ate­ly and post­pones the bulk of the sav­ings for nine or ten years.

That sav­ings are back-loaded is unavoid­able. Repub­li­cans have often advanced, sup­port­ed and vot­ed for tem­po­rary relief from cuts whose costs are paid off over time. Spar­ing doc­tors from sharp drops in Medicare reim­burse­ment – some­times for a year, some­times for less – has become a bipar­ti­san Con­gres­sion­al tra­di­tion. The costs of that relief are incurred straight­away; the off­set­ting sav­ings typ­i­cal­ly take a decade to accu­mu­late. That is but one exam­ple of some­thing that is char­ac­ter­is­tic of bills that Democ­rats and Repub­li­cans alike have sup­port­ed. To object in this one case is just a bit disingenuous.

Such objec­tions also are odd because the agree­ment is so small – the $63.2 bil­lion amounts to a 0.77 per­cent increase in fed­er­al spend­ing over the next two years; the $22 bil­lion in deficit reduc­tion a mere 0.3 per­cent improve­ment in pro­ject­ed short­falls. It is sim­ply too incon­se­quen­tial to jus­ti­fy the feroc­i­ty of crit­i­cism that some con­ser­v­a­tives have launched.

The deal was reached pri­mar­i­ly because it came at the right moment, fol­low­ing a roller-coast­er ride dur­ing which both par­ties threw up on them­selves mul­ti­ple times. The year dawned with the Pres­i­dent win­ning his increase in income and pay­roll tax­es, a dispir­it­ing defeat for House Repub­li­can lead­ers. Con­gress then defied the President’s efforts to derail the first round of across-the-board cuts, leav­ing him to look weak and inef­fec­tu­al as the pub­lic ignored his dec­la­ra­tions about how dev­as­tat­ing the cuts were. Repub­li­cans were next to soil them­selves, insist­ing that they could defund Oba­macare on a stop­gap spend­ing bill, pro­duc­ing instead a gov­ern­ment shut­down that left them dis­cred­it­ed. But not for long. Their blun­der was fol­lowed almost imme­di­ate­ly by sto­ries about the bun­gled healthcare.gov web­site and the President’s grudg­ing acknowl­edge­ment that mil­lions had lost insur­ance cov­er­age he had repeat­ed­ly promised they could keep.

Even politi­cians some­times grow weary of polit­i­cal con­flict, espe­cial­ly after ser­i­al humil­i­a­tions. Both par­ties saw the ben­e­fits of a bud­get truce and both were hap­py to tell naysay­ers in their respec­tive bases to take a hike.

Repub­li­cans stand to ben­e­fit most from the result­ing peri­od of tran­quil­i­ty. When Con­gress returns after the hol­i­days, the real prob­lems with Oba­macare will begin to sur­face: many who had cov­er­age for years will find that they are new­ly unin­sured, many who thought they had enrolled in poli­cies will learn that they don’t have cov­er­age, many who are cov­ered will find out that they can no longer see their doc­tor or receive care from hos­pi­tal sys­tems in their area. Con­sumers will com­plain about high pre­mi­ums, bur­den­some cost-shar­ing, nar­row net­works and restric­tive drug formularies.

Com­pared with those prob­lems, a dodgy web­site and mil­lions of can­cel­la­tion notices will seem insignif­i­cant by com­par­i­son. The White House will need a dis­trac­tion from the health law’s fail­ings. That is one rea­son why Sen­ate Major­i­ty Leader Har­ry Reid recent­ly announced that the Sen­ate would take up a bill to extend unem­ploy­ment ben­e­fits in Jan­u­ary. But such a bill, like ini­tia­tives to raise the min­i­mum wage and change immi­gra­tion laws, are unlike­ly to divert atten­tion from the health care flop.

Anoth­er bud­get stand­off, with the threat of anoth­er gov­ern­ment shut­down on Jan­u­ary 15, might have done the trick. The bud­get deal almost cer­tain­ly takes that off the table, assum­ing the Sen­ate fol­lows the House’s lead and adopts the compromise.

Lack­ing that dis­trac­tion, the Pres­i­dent will find him­self in a very weak posi­tion. Democ­rats who have been asked to trust the Admin­is­tra­tion despite the law’s stum­bling roll-out may well wan­der off the reser­va­tion once the next wave of bad news breaks. They could begin to insist on changes to the law that could fur­ther dam­age its trou­bled imple­men­ta­tion, pre­sent­ing Repub­li­cans with a huge opportunity.

Which is why Speak­er Boehn­er laced his state­ments last week with unchar­ac­ter­is­tic ran­cor and brava­do. After a year of hav­ing to accept ill-con­ceived leg­isla­tive strate­gies devised by back-benchers, inter­est groups and radio talk show hosts, the bud­get vote leaves Boehn­er the unques­tioned leader of his con­fer­ence. That gives him the upper hand, should the White House and Con­gres­sion­al Demo­c­ra­t­ic lead­ers lose their hold on mem­bers. By this time next month, the Speak­er may be in a posi­tion to nego­ti­ate the con­tours of a bipar­ti­san bill that would sev­er the tie between the insur­ance indus­try and the admin­is­tra­tion on which the suc­cess of Oba­macare depends.

That out­come is hard­ly assured. The task is daunt­ing, the pol­i­tics del­i­cate. But the bud­get deal accom­plish­es two impor­tant things for Repub­li­cans: it removes a poten­tial dis­trac­tion from Oba­macare by avert­ing a Jan­u­ary gov­ern­ment shut­down and it leaves the Speak­er free to devise and exe­cute a leg­isla­tive strat­e­gy with­out inter­fer­ence from out­side groups.