WASHINGTON – How many federal bureaucrats does it take to carry out President Barack Obama’s health care overhaul? Don’t expect to find an easy answer in his new budget.
It has no line item for health care implementation, a task delegated to agencies in several government departments, each with its own procedures — and quirks — to account for spending and hiring.
Republicans suspect a dodge to make it harder for them to track the money as they strategize over how to block the law by shutting off the spigot of federal funds.
“They are absolutely hiding the ball with this budget,” complained Rep. Dave Camp, R-Mich., chairman of the House Ways and Means Committee, which oversees Medicare and tax laws. “We don’t know the cost of the health care bill or how many people they are going to hire. All of this needs to be flushed out.”
Administration officials say the $3.7 trillion budget may be hard to read, but it’s all in there. Somewhere.
“Nothing is being hidden,” said Richard Sorian, a spokesman for the Health and Human Services Department, which is leading the effort to expand health coverage to more than 30 million uninsured people by 2014.
It’s just that it may not be easy to see.
Part of the reason, the White House says, is that multi-tasking government workers are expected to carry out the health care law along with their other duties. “When you look at an agency, it’s very hard to say this person works only on that law,” explained Kenneth Baer, a spokesman for the president’s budget office.
“The Affordable Care Act is built on top and interwoven with existing statutes and authorities, and it would be extremely difficult to separate or disaggregate the impact of that on the budget,” said Baer.
Some agencies have been more helpful with details than others.
The Internal Revenue Service, for example, says it will need 58 revenue agents to enforce the law’s 10 percent sales tax on indoor tanning, which went into effect last year.
“As many as 25,000 businesses provide indoor tanning services,” says the agency’s budget. “These entities typically do not have experience filing federal excise tax returns.” It looks like that will soon change. The IRS expects to close 1,000 tanning tax cases annually by 2013.
Overall, Treasury’s budget includes $473 million and 1,270 employees to administer the health care law. A spokeswoman said most of them won’t be working on enforcement. Many will be helping with tax credits intended to make health insurance more affordable for small businesses and households. Others will be setting up new technology. The IRS will eventually be responsible for collecting fines from taxpayers who ignore a new requirement to carry insurance.
HHS, the hub of health care implementation, is providing less budget detail. The department says only 252 people will be working full-time on the new law, all of those in the Center for Consumer Information and Insurance Oversight. The new agency was part of Secretary Kathleen Sebelius’ office last year and has been transferred to the HHS division that oversees Medicare.
Most of the rest of the work will be handled by multi-tasking employees, said spokesman Sorian.
Overall, HHS says it’s getting $465 million to carry out the law. About $120 million goes to the Administration on Aging, which is trying to salvage one of the law’s major new programs, a voluntary long-term care insurance fund intended to help elderly and disabled people avoid going into nursing homes. The Community Living Assistance Services and Support program would provide a benefit of at least $50 a day in cash to help with expenses such as paying a caregiver.
But Sebelius told lawmakers last week she’s concerned the program as written by Congress is financially unsustainable, while confident that premiums, eligibility rules and other factors can be tweaked to fix the problems. The law gave HHS authority to make significant changes in the long-term care plan.
Republicans want to repeal the whole law, but if they can’t succeed, they’ll try to pick off the long-term care plan. Last week, the GOP-led House voted to deny the administration any money to carry out Obama’s overhaul.