Democrats Welcome Health Care Spending Fight With Republicans

As much as conservatives would like Wednesday’s House vote on repealing health care to be binding, it’s really just symbolic. The Republicans’ real legislative leverage over the bill will come during spending fights later this year, when the GOP appropriators in the House can demand funding cuts to stymie the implementation of the law.

Democrats in the Senate will object, and if the two chambers don’t break the gridlock, it could even lead to a government shutdown. To push the GOP back from the brink, Democrats will cast the skirmish with Republicans not as an abstract fight over spending, but as a disagreement between the parties over providing benefits to people.

At a health care event in the basement of the Capitol on Wednesday, top Democrats laid this strategy out. “I think we have to discreetly respond, ‘This is what withholding funding for this aspect of [the law] — this is what it means to you,'” said House Minority Leader Nancy Pelosi.“I think the things that they would attack now are things that are direct services to American people,” said Rep. John Yarmuth (D-KY). “They would have to start saying, well we’re going to wack the spending for the donut hole, and for preventive care, and for things that are direct services to American citizens.”

Some Republicans want to use the appropriations process to block the IRS from administering the mandate, and the Department of Health and Human Services from helping states set up insurance exchanges ahead of 2014.

“What are they going to cut? There’s very little administrative costs being expended, I mean you could do it, but they’d find ways to shuffle money around in the department,” Yarmuth said.

To illustrate the conundrum, Yarmuth pointed out that the law expands Medicaid to cover people up to 133 percent of the poverty line, and that the federal government pays for that expansion through the end of the decade.

“You’re going to go in and now say to states ‘you’ve got to provide the service now — that’s in the law — but we’re not paying you,'” he said.

“We’ll just see how irresponsible [Republicans want to be],” Pelosi said.