Shutdown looms as House delays ACA in stopgap spending bill that now moves to the Senate

Defying Senate Democrats and critics in their own party, House Republicans pushed through a short-term spending bill early Sunday that increases the likelihood of a government shutdown by requiring a one-year delay in implementing and funding the Patient Protection and Affordable Care Act. The measure also would allow employers and healthcare providers to opt out of mandatory contraception coverage included in the ACA. The bill is seen as dead on arrival in the Democratic-controlled Senate.

With two days left in the fiscal year, House members changed the Senate's recently passed stopgap spending measure with one amendment to postpone the healthcare reform law and another amendment to repeal law's 2.3% medical device excise tax. Senate leaders have said neither measure will pass in the upper chamber, which heightens the possibility that government operations will shut down after Sept. 30 unless lawmakers can reach an agreement.

The last government shutdown was 17 years ago. About 800,000 federal workers deemed non-essential would be furloughed, and millions more would work without being paid. But the House bill would ensure that all military personnel would continue to be paid.

On Saturday, Senate Majority Leader Harry Reid (D-Nev.) released a statement indicating the House GOP's efforts to dismantle the Affordable Care Act – either through a mandatory government funding bill or later in legislation to raise the nation's debt ceiling – won't succeed.

"To be absolutely clear, the Senate will reject both the one-year delay of the Affordable Care Act and the repeal of the medical device tax," Reid said in a statement. Repealing the tax, which would raise about $30 billion over 10 years to help pay for the Affordable Care Act's insurance premium subsidies and other provisions, has bipartisan support in both the House and the Senate though some key supporters of repealing the tax say the continuing resolution measure is not the right vehicle for doing so. There's no agreement on how to replace the revenue if the tax is repealed.

Speaking on the House floor late Saturday night, Rep. Erik Paulsen (R-Minn.), the sponsor of a bill the House passed last year to repeal the device tax, contended that the tax has led to the loss of 10,000 jobs, hampered innovation, and hurt patient care. He also reminded his House colleagues that 79 senators, including 33 Democrats, voted to repeal the tax in an amendment to the Senate's budget resolution in April. Paulsen re-introduced his bill in the House earlier this year and said it now has the support of 263 co-sponsors and 975 organizations.

But in a news conference late last week, Reid said if lawmakers want to consider eliminating the tax, they should do so in separate legislation. Sen. Amy Klobuchar (D-Minn.) and Sen. Orrin Hatch (R-Utah), both supporters of repeal, said the same thing last week.

Meanwhile, the Obama administration released a statement saying that the House, in proposing the amendments to the Senate spending bill, has chosen to "advance a narrow ideological agenda and threaten the nation's economy. By including extraneous measures that have no place in a government funding bill and that the President and the Senate already made clear are unacceptable," the statement continued, "House Republicans are pushing the government toward a shutdown." The White House said the president would veto the legislation if he's presented with it.

After the votes early Sunday, Rep. Mike Burgess (R-Texas), told Modern Healthcare that if the government does close down, it probably would be only for a day or two. "If there is one, I expect it to be relatively short-lived," Burgess said.

The House-passed legislation, which would keep government programs and services funded at the current, post-sequestration, annual rate of $986 billion through Dec. 15 -- a month longer than the Senate's continuing resolution bill. The Senate also approved a continuation of the across-the-board cut to Medicare providers capped at 2% under sequestration, although Democrats are unhappy about continuing the sequester. The House measure now moves back to the senate, which will be back in session on Monday afternoon..

The big question is which party will receive the bulk of the blame from voters if the government shuts down.