No appropriations could mean no new guidance or enforcement from federal agencies, though legally, HHS and the Internal Revenue Service would still be required to deliver on the law, the CBO said.
The deficit may grow in some cases and decline in others as a result of the funding freeze, the CBO said.
States and the marketplace would await guidance that may never come. Collection of rebates required from drugmakers could falter. (Drug savings for Medicaid would total $48 billion through 2021.) Enforcement of the individual insurance mandate could languish. Should the Independent Payment Advisory Board (which has its own budget, unaffected by an appropriation freeze for the health reform law) produce ideas to slow Medicare spending, HHS could be powerless to adopt them. The CMS may be unable to enter into Medicare Advantage and Part D drug plans, the CBO said.
The letter was more certain on what the lack of funding would mean for the uninsured. Projected health insurance coverage gains would not materialize, the CBO said.
“By reducing or preventing enforcement of the mandate to obtain insurance coverage, support for states to expand their Medicaid programs, the availability of new insurance exchanges, and the use of tax subsidies for insurance purchased through those exchanges, a permanent prohibition on the use of discretionary funding would reduce the number of people with health insurance coverage compared with what would occur if the healthcare laws are fully implemented.”
Insurance coverage through the law's exchanges, estimated to total 20 million by 2021, would fall short of projections, the CBO said.
Meanwhile, federal funds for Medicaid and the Children's Health Insurance Program would continue, but states may lack needed guidance from CMS should discretionary funds dry up.
Notably, Medicaid enjoyed public support in the month's Kaiser Health Tracking Poll, which surveys a nationally representative sample of adults by phone, but opinion of the health reform law remains mixed.
The poll sounded out public attitudes for plans to convert Medicaid funding to block grants, and found 60% preferred no change to federal Medicaid financing, which guarantees matching funds for state spending. Roughly one-third, 35%, favored block grants. Nearly equal numbers approved and disliked the health reform law, with 42% reporting a generally favorable opinion of the law and 44% with generally unfavorable opinions.