Implementation of the Affordable Care Act (ACA)

Late on March 5th North Carolina Governor Bev Perdue (D) vetoed legislation approved by the Republican-held legislature that would block the ACA’s individual mandate in the state. The first-term governor, who has seen her approval ratings slip significantly since her election in 2008, had made earlier statements indicating that she would sign the legislation into law, predicting that her veto would be a distraction to her top priorities of working with the GOP on education and the economy. The state’s General Assembly will hold a vote to try to override the governor’s veto, but it is unclear if they have the votes. Meanwhile, the Tennessee House of Representatives voted on March 7th to pass a health care “freedom act,” which would attempt to allow state residents to choose or reject health insurance of their choosing without government penalties. On the federal level, Rep. Mike Rogers (R-MI) announced that he had introduced legislation on March 10th to allow all individuals and businesses to seek waivers from mandates in the ACA.

On March 7th the GOP majority staff on the Energy & Commerce Subcommittee on Health staff released a memorandum on the mandatory spending in health care law they want to eliminate. Among the items mentioned were spending for state-based exchanges, the prevention and public health fund, the construction and capital cost fund for school-based health centers, the personal responsibility education program, and the teaching health centers development grants. The memo was released in advance of a hearing held on March 9th during which the GOP majority took aim at numerous funding streams within the ACA. More information, including the background memo on that hearing can be found here. On March 10th the CBO released an analysis noting that blocking ACA funds in the short-term would produce some deficit reduction – approximately $1.4 billion for the rest of the fiscal year – but that it would raise the deficit over the long-term.