On the statewide speaking circuit, U.S. Sen Ted Cruz has made upending the federal Affordable Care Act sound simple: “The House of Representatives should pass a continuing resolution that funds the entire federal government, every bit of the federal government, except Obamacare,” he told a group of Houston realtors last month.
Now entering his third week on the road in a tour of primarily Texas cities, Cruz has only amplified his message, encouraging grassroots supporters to sign an online petition and contact their lawmakers to support this defunding approach. At one of his first stops in Kingwood in mid-August, the petition website DontFundObamacare.com had roughly 300,000 signatures. Today more than 1 million people have signed on.
But despite Cruz's fervor, it's not an idea many of his Republican colleagues are getting behind, including Cruz's Texas counterpart, U.S. Sen. John Cornyn. In July, Cornyn, the Senate minority whip, withdrew his signature from a letter drafted by 11 U.S. House Republicans including Cruz demanding that Congress defund the health reform law as a condition for approving the rest of the budget.
“Among the opponents of the Affordable Care Act, there’s a growing sentiment that the defunding effort is fruitless,” said Edwin Park, vice president of health policy at the left-leaning Center for Budget and Policy Priorities.
In an email, Cruz spokeswoman Catherine Frazier indicated that the senator was directing his efforts at the voting public, not at his congressional colleagues.
"The senator has said time and again that the only way we can win the fight is if Americans stand up and demand it of their elected officials," Frazier wrote. "He believes if this happens, we can win."
It's still unclear exactly what effect defunding federal health reform would have — and who would stand to lose most.
Park said that while "defunding would block implementation,” the law would still be on the books, so Americans would still be required to carry health insurance under the individual mandate. The IRS just wouldn’t have the funding needed to assess penalties.
Parts of the law have already been rolled out gradually; many Americans have become accustomed to provisions like letting young adults remain on their insured parents' policies up to age 26.
And since 2010, $99.9 million in grants tied to the Affordable Care Act have been awarded to the five Texas agencies that manage health: the Departments of Insurance, State Health Services, Health and Human Services, Aging and Disability Services and Family and Protective Services.
Those federal dollars pay for a variety of programs that do things like expand electronic records use for immunizations, facilitate elder abuse intervention, and promote cervical cancer screenings and HIV prevention. Stephanie Goodman, a spokeswoman for the Health and Human Services Commission, said the funding isn't to implement or enforce federal health reform; many of these programs existed before it became law. But now the funding flows through the Affordable Care Act.
“As to what would happen to those programs and long-standing grants if ACA was defunded, it’s not clear,” Goodman said.
As Congress returns from its August recess, the GOP strategy may be shifting to measures that would delay implementation — of the health insurance marketplaces, slated to go online Oct. 1, and the individual mandate, expected to take effect Jan. 1.