US government reopens as Republican effort to derail health act collapses

BMJ 2013; 347 doi: (Published 18 October 2013) Cite this as: BMJ 2013;347:f6336
  1. Michael McCarthy
  1. 1Seattle

An effort by US Republicans to derail the Affordable Care Act that shut down the federal government for three weeks and threatened a default that rattled financial markets around the world collapsed Wednesday in what is widely seen as a debacle for the party.

The standoff ended late Wednesday night when the Senate and then the House of Representatives passed a temporary spending measure that will finance the government until 15 January and raise the nation’s debt limit until 7 February. The bill passed the Senate 81-18 and the House by a vote of 285-144. President Barack Obama signed the legislation around 12:30 am Thursday.

The standoff began 29 September when the Republican led House of Representatives passed a continuing budget resolution that contained a provision that would have defunded the Affordable Care Act, the 2010 healthcare reform law often called “Obamacare.”

The Democratic majority in the Senate rejected the House bill and sent a version back that did not have the defunding provision. The House, in turn, responded by passing a new version of the bill that would delay the healthcare law by one year, allow employers and healthcare providers to opt out of the law’s requirement that they provide coverage of contraceptive services, and require Congress and its staff to pay for health insurance without current subsidies. The Senate rejected those provisions as well.

On 30 September, the last day of the fiscal year, the House passed another version of the bill. This version included a provision that would delay the healthcare law’s individual mandate (requiring individuals to have health insurance) for one year and, again, cut off the health insurance subsidies currently provided for members of Congress and their staff.

That evening the Senate rejected the bill and sent a new version, stripped of the provisions targeting the healthcare reform law, back to the House. The next day, 1 October, without Congress’s authorization to fund the government services, President Obama ordered a partial shutdown of the federal government, furloughing 800 000 federal workers whose work was deemed “non-essential.”

That same day, the healthcare insurance exchanges, a key component of the Affordable Care Act, opened for business across the country.1 Paradoxically, the rollout was unaffected by the shutdown, because the law’s implementation had been fully funded in the original legislation.

In the ensuing stalemate House Republicans continued to seek to delay or alter different aspects of the Affordable Care Act, but Senate Democrats and President Obama refused to budge and called for a “clean budget resolution” that was free of language targeting the legislation.

As the battle in Washington wore on, public dissatisfaction with both parties grew, but increasingly Republicans were seen to be to blame. An NBC News and Wall Street Journal poll found that the public faulted the Republicans more than Obama for the impasse, by 53% to 31%. The numbers were “jaw dropping,” one veteran pollster told NBC News.

Pressure was also building for Congress to act on a second key piece of legislation, a bill to raise the government’s debt limit so it could continue to borrow to pay its bills and creditors. If the US were to default on its payments, financial experts here and abroad warned, it could trigger a worldwide recession worse than that that began in 2008.

Even the Wall Street Journal, a strong opponent of Obama and his healthcare legislation, called on Republicans to throw in the towel. “It’s time to wrap up this comedy of political errors,” the journal editors wrote.2

In the end Congress passed the legislation with only one provision relating to the healthcare law, one requiring that the government ascertain the incomes of those seeking federal subsidies to make sure they were eligible, a requirement that administration officials said would have no effect on implementation.

Writing in the Wall Street Journal, Karl Rove, a former White House adviser to President George W Bush and Republican strategist, blamed the debacle on a small cadre of ultra-conservative House Republicans who, he said, had pursued their effort to defund the healthcare law long after the strategy had been shown to be a “transparent failure.”

“Backers of the defund strategy never offered a plausible way forward after their approach failed. Instead, they alienated colleagues who disagreed by insisting they were closet ObamaCare supporters and the defunders’ outside allies raised the threat of primary challenges. They became content to sit in judgment of plans offered by the House leadership, turning thumbs down on anything not in conformity with their now discredited tactic,” Rove wrote.3

Their intransigence played into the president’s hands, Rove said. “Barack Obama set the trap. Some congressional Republicans walked into it. As a result, the president is stronger, the GOP [Republican Party] is weaker, and ObamaCare is marginally more popular,” Rove wrote.

In remarks given Thursday, Obama called on Democrats and Republicans to work together to tackle issues such as agreeing to a budget, reforming the nation’s immigration policy, and passing the stalled farm bill.

“To all my friends in Congress, understand that how business is done in this town has to change. Because we’ve all got a lot of work to do on behalf of the American people—and that includes the hard work of regaining their trust,” Obama said.

But the House speaker, John Boehner, an Ohio Republican, vowed to continue the fight against the Affordable Care Act.

“Our drive to stop the train wreck that is the president’s healthcare law will continue. We will rely on aggressive oversight that highlights the law’s massive flaws and smart, targeted strikes that split the legislative coalition the president has relied upon to force his healthcare law on the American people,” he said.


Cite this as: BMJ 2013;347:f6336


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