File this under unintended consequences. If House Republicans get their way and prevent President Obama from using any discretionary appropriations to implement “Obamacare,” it would cripple existing Medicare programs, many of which are operated under methodologies enacted in the health care law.
“If H.R. 1 were enacted, the Centers for Medicare & Medicaid Services (CMS) would not be able to use CR funds to administer payments based on any rate calculated on the basis of the provisions of the Affordable Care Act — which is to say virtually all rates,” she writes.
Among many other things, the law rescinded the old methodology by which the government paid Medicare Advantage providers and replaced it with a new one. The House spending bill would prohibit HHS from making payments under the new regime. And with the old regime eliminated, the department would have no legal authority to cover those services, according to Sebelius.
“This would seem to mean that payments to [Medicare Advantage] organizations would have to be suspended, risking a significant disruption in services to beneficiaries enrolled in Medicare Advantage,” Sebelius writes.
Even in cases where HHS has retained the authority outside of the health care law to make payments to various providers, they’d have to establish new rules and rates governing those payments — a process that would take months. “While the new rates were implemented, CMS would be prohibited from paying providers and suppliers at the Affordable Care Act rates.”
Under the House plan, HHS would also be prohibited from covering annual wellness visits for the elderly, and continuing other programs for early retirees and people with pre-exisitng conditions. President Obama’s promised to veto H.R. 1, and Republican aides privately acknowledge that this provision won’t survive bipartisan spending negotiations. But you can see they really thought this one through. Read the Baucus/Sebelius correspondence here.
Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight, and the debt limit fight. He can be reached at firstname.lastname@example.org.