Jobs related to health law at risk

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There is little precedent for cutting funding after a law is struck down. | JAY WESTCOTT / POLITICS

By J. LESTER FEDER

If the Supreme Court puts an end to health care reform, its removal could be almost as controversial as its implementation in the first place.

And the hundreds of federal employees in the agencies created or expanded health law could find itself at the center of a new round of fighting. These positions are based on the Affordable Care Act dollars that the court could take away by finding the entire law unconstitutional.

“Hang on for Civil War II,” said Douglas Holtz-Eakin, of the American Action Forum, former head of the Congressional Budget Office and presidential campaign advisor to Senator John McCain.

There is little precedent for cutting federal spending when the allocation law is declared unconstitutional. Much could still be worked out by the White House and Congress – and the decisions would affect the new offices and agencies, the livelihoods of the men and women who work there, and the status of the multi-year contracts and projects they have undertaken. . to.

It is likely that some of the health reform staff will be reabsorbed into other health and social services offices, where a number worked before the health care law was passed two years ago. But some could end up without a job – and without their health benefits.

Offices created to implement the health reform law include the Center for Consumer Information and Insurance Oversight and the Center for Medicare & Medicaid Innovation. The consumer office is drafting new insurance rules for the health law, and the Innovation Center is experimenting with different payment models for entitlement programs.

Neither the Center for Medicare & Medicaid Services nor the White House would comment on this story, but HHS records show that around 500 people work for these two offices. A recent Republican Senate analysis of federal jobs data found that thousands of new HHS workers are busy implementing the health care law, with around 3,000 new positions in the secretary’s office alone.

HHS Secretary Kathleen Sebelius is set to decide whether to let the workers go if the tribunal withdraws funding and mission from offices related to health reform or somehow uses its discretion out of the department’s budget to keep them in an attempt to advance the administration’s health goals, even without ACA.

Even if she can find ways to keep them, they might still be missing if Mitt Romney wins the presidency.

Some employees in these offices may already be funded by dollars from routine appropriation bills that provide the general operating budget of HHS, according to budget experts. This money would not be directly affected by a ruling against the health reform law.

But the fate of these offices depends on how the Obama administration mobilizes the funds that remain at its disposal.

“The problem you’re looking at here is cash flow,” said Jim Dyer, former Republican personnel director of the House Credit Committee, who is now director of the Podesta Group.

The federal spending pipeline is complex, and secretaries have a lot up their sleeve. Even if the courts overturn the health care reform bill, Dyer said, it will still be on Congress to turn off the tap completely.

“If I am an appropriator,… I would like to draw a hard line in the sand,” he said. The committee could immediately demand that the HHS cease spending if the court overturns the law so that it can exercise tight control over how it terminates the program. Exactly how it would be if a Republican-controlled House committee wanted the HHS to stop spending, but a Democrat-controlled Senate not, was part of uncertain political ground.

The future of healthcare reform workers is just one of many questions about what happens to ACA dollars if the Supreme Court overturns the entire law. They are so novel that few in the healthcare or legal world feel as though they know how to answer them.

“God only knows,” said Tim Westmoreland, a longtime member of Representative Henry Waxman (D-Calif.) Who also led Medicaid under President Bill Clinton. He is now a Senior Fellow at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center.

If the court found the entire law to be unconstitutional, that could theoretically mean that all expenses made on its behalf are also unconstitutional, from checks sent to cover drug costs for Medicare beneficiaries to grants to states to help them put. up their insurance markets.

However, few experts believe the court will require the federal government to recover this money, even if it overturns the entire law.

“I presume anything that has been committed is undone and will not be recovered in any way,” said Ron Pollack of Families USA.

But what it means to “spend” money is not that simple.

The government is not likely to retroactively bill a Medicare patient for this free colonoscopy. But what about the money the Innovation Center used to underwrite multi-year contracts it signed with healthcare systems to try new ways to get paid under insurance? -sickness ? Or similar contracts that Medicare has entered into under the Accountable Care Organization program created with the authority of the ACA?

The federal government has made a commitment to spend the money on these projects, although not all has been spent.

The fate of these deals may depend on the details of the court’s decision – or, if the court does not give detailed instructions on stopping health care reform, the outcome of the next round of care battles. between Congress and the White House.

The only thing that seems certain about what will happen to the ACA dollars if the court makes a broad decision, said Georgetown law professor Michael Seidman, is that “unraveling all of this … is going to be a mess.”

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