Rep. Michele Bachmann's claim that Democrats "secretly" hid $105 billion in health care spending is way off base. It's true that the new health care law contains many billions in future spending, but there was no secret about that.
The Minnesota Republican told "Meet the Press" host David Gregory that "secretly, unbeknownst to members of Congress, over $105 billion was hidden in the Obamacare legislation to fund the implementation of Obamacare." But the truth is that much, if not all, of that money was well known before Congress voted on the bill — a fact that drew the wrath of Bachmann's colleagues, including Sen. Thad Cochran, the ranking Republican on the Senate Appropriations Committee.
The health care law, for example, mandates funding for these big-ticket items that were much debated and discussed prior to the final vote:
$40 billion to fund the Children's Health Insurance Program (CHIP) in fiscal years 2014 and 2015. Congressional authorization of CHIP was due to expire at the end of fiscal year 2013, but the health care law extended it for two years.
$11 billion over five years for community health care centers, a figure that was arrived at when President Barack Obama publicly proposed a compromise between the $7 billion in the Senate bill and the $12 billion in the House version.
$5 billion in one-time funding to create a temporary high-risk pool for people with preexisting conditions until a law can take effect banning insurance companies from refusing to cover such individuals.
Since early March, Bachmann — the head of the congressional Tea Party Caucus — has claimed in interviews and press releases that the Patient Protection and Affordable Care Act contained $105 billion in hidden funding. In a March 3 video posted on her YouTube website, Bachmann said "practically no member of Congress even knew that $105 billion of funding was contained" in the health care law, which gained final passage March 21, 2010, and was signed into law two days later.
In a March 2 interview with Fox's Greta Van Susteren, Bachmann cited an October 2010 report by the Congressional Research Service as her primary source for the "hidden" spending. The CRS report, titled "Appropriations and Fund Transfers in the Patient Protection and Affordable Care Act," provided eight pages of mandated appropriations and fund transfers required by the law.
Bachmann: Most members of Congress don't even know.
Van Susteren: Because they never bothered to read it?
Bachmann: It isn't that they didn't bother to read it. It was hidden. As a matter of fact, a report came out just in October, Congressional Research Service, that revealed for the first time that over $105 billion was appropriated.
Bachmann, March 6: There was a Congressional Research Service report that just was issued in February, and we discovered that secretly, unbeknownst to members of Congress, over $105 billion was hidden in the Obamacare legislation to fund the implementation of Obamacare. This is something that wasn't known. This money was broken up, hidden in various parts of the bills.
Neither CRS report describes the funding as "hidden." And both total a little more than $100 billion in mandated appropriations and fund transfers over 10 years. So, where did Bachmann learn about this supposed deception?
On March 4, Bachmann issued a press release crediting former congressman Ernest Istook — who is now at the conservative Heritage Foundation — for working "to uncover this startling new information." Bachmann's press release links to Istook's Feb. 15 opinion piece in Human Events on the law's "dirty little secret." In his article, Istook refers readers to a Jan. 27 report he wrote for Heritage, "How to Limit the Damage from Obamacare — Pulling it Out Weed by Weed."
We looked at the reports by Istook and the CRS and found few secrets. For example, Istook notes that the "two largest single amounts" of "locked-in future spending" — about $40 billion of the $105 billion — will fund a two-year extension of CHIP. But there was a very public debate about whether to let CHIP expire after fiscal year 2013 and allow the children to be covered by Medicaid (as proposed by the House Democrats) or fund CHIP for two more years through fiscal year 2015 (as proposed by the Senate). The final bill extended CHIP for two more years and provided the funding for it.
Istook, Jan. 27: The CRS devotes eight pages to a table listing the billions of locked-in future spending. The two largest single amounts are an appropriation of $19.147 billion for FY 2014 and $21.061 billion for FY 2015 for the Children’s Health Insurance Program (which existed before Obamacare).
Unlike Bachmann, Istook's report makes no claim that the Democrats secretly hid funding in the health care law. Instead, it argues that the legislation was "deliberately designed" to make defunding of the law difficult because of these "advance appropriations." Difficult, but far from impossible. "As with every other federal program," he writes, "the level of funding can be adjusted — even zeroed out — by the current Congress." That's exactly what he advocates doing.
In an e-mail to us, Istook said it is "within the range of fair comment and opinion" for Bachmann to say that funding for these and other programs was a secret because "the usual course is for legislation to authorize appropriations to be made, not to include them in the legislation that creates programs." He added: "The fact of the huge amount of advance appropriations has undoubtedly been largely unknown to most people and certainly was not trumpeted loudly by sponsors of the measure."
Largely unknown to most people, perhaps, but not those who read the bill or followed the debate — including members of Congress.
On Feb. 22, 2010, three days before his "health care summit" with invited members of Congress, the president unveiled his health care proposal in an attempt to reconcile the differences between the House and Senate bills. Obama's proposal provided funding to continue CHIP, siding with the Senate. Georgetown University's Center for Children and Families put out a press release that day that said: "CHIP would be funded through September 30, 2015, two years beyond its current expiration date."
The president's proposal also included $11 billion for community health centers — one of the other big-ticket items listed in the CRS reports cited by Bachmann. The White House released a summary of his proposal that included this description:
White House, Feb. 22, 2010: Invest in Community Health Centers. Community health centers play a critical role in providing quality care in underserved areas. About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care. The Senate bill increases funding to these centers for services by $7 billion and for construction by $1.5 billion over 5 years. The House bill provides $12 billion over the same 5 years. Bridging the difference, the President’s Proposal invests $11 billion in these centers.
Throughout the debate, the nonpartisan Kaiser Family Foundation provided charts comparing the various health care bills and policy papers explaining major proposals — such as a January 2010 paper on creating temporary high-risk pools for people unable to get health insurance because of preexisting medical conditions. Of the high-risk pools, Kaiser wrote: "Congressional health reform bills would establish a National High-Risk Pool Trust Fund and appropriate $5 billion to support the program over the duration of the reform implementation period." In its final chart summarizing the new law, Kaiser made more than a dozen references to money being appropriated for programs big and small — ranging from the high-risk pools ($5 billion) to expanding the role of the Medicaid and CHIP Payment and Access Commission ($11 million). Both items were also included in the CRS list of mandated appropriations.
The fact that the bill contained mandatory funding rankled Republicans at the time. On the eve of the health care debate in the Senate, the top-ranking Republican on the appropriations committee criticized the Democrats for bypassing the annual appropriations process in drafting the health care bill and other legislation. In a floor speech, Cochran made the same point Istook did in his report, warning that "once a funding stream is made mandatory, it is extremely difficult to reduce or cut off the spending."
Cochran, Nov. 19, 2009: Of most immediate concern is the health care bill on which we will soon begin debate.
The bill reported by the Senate Finance Committee creates new programs with direct appropriations that should be funded or not funded through the annual appropriations process. There are mandatory programs for maternal, infant, and early childhood home visitation and for personal responsibility education for adulthood training. There are grants for school-based health centers, a demonstration program for emergency psychiatric care, and a demonstration program to address health professions' workforce needs.
A previously authorized childhood obesity program is directly funded with a mandatory appropriation. Many of these programs are funded for only a few years, just enough time to get funding recipients invested in the program, after which expectations will be overwhelming that the programs be continued with annual appropriations.
We understand Cochran's and Istook's point that legislation typically does not both authorize and appropriate funds. But Bachmann is just wrong to characterize the mandated appropriations in the health care law as "hidden." It was, as the saying goes, hidden in plain sight.