The budget 'justification' was released Friday morning. Obamacare money under the couch

The Obama administration is dropping some new hints about how it has moved money around to fund Obamacare without Congress — but not nearly enough to put the controversy to rest.

Forced to reveal more details under a provision tucked in this year’s bipartisan budget deal, the Department of Health and Human Services declared Friday how it used Secretary Kathleen Sebelius’s authority to move about $1.6 billion in departmental funds around last year — the Cabinet secretary’s version of looking for change under the couch cushions and hitting the jackpot.


But HHS didn’t say exactly how it spent the money, and it didn’t lay out the kind of detail Republicans sought. So now the Republicans will have to decide their next move, whether it’s just more records requests or new efforts to tie the Obama administration’s hands in future appropriations bills.

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And even though it will be able to get some money from fees on insurers’ selling plans on HealthCare.gov in future years, the Obama administration will still have to decide how it can keep Obamacare afloat if Congress keeps refusing to provide new funding.

Here are the lessons from Friday’s report:

What we know: The big reveal is no surprise: The Obama administration got most of the money last year from Sen. Tom Harkin’s cherished Prevention and Public Health Fund. But the report also told us more about the other couch cushions — as the administration pulled money from various all-purpose department funds to help launch the law’s new health insurance exchanges.

A one-page table from the official explanation of the administration’s HHS budget shows that federal officials diverted more than $450 million from that prevention fund — which Republicans call a “slush fund” — to finance Obamacare work, including building HealthCare.gov.

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They also pulled $300 million from something called the Non-Recurring Expenses Fund, an account that allows an agency to use money left over from prior years for one-time expenses.

And they found $268 million from the general program operations account at the Centers for Medicare & Medicaid Services — the main agency within HHS that’s implementing the health law — plus another $113 million from Sebelius’s “transfer authority.”

The numbers appear on page 349 of the budget justification, which lays out the reasoning for President Barack Obama’s latest budget request. It’s there because the omnibus spending bill signed in January required HHS to use that report to detail its Obamacare spending.

What we don’t know: The report doesn’t say anything about how the money was spent — just where it came from. It also doesn’t say how much more there might be from the sources that have been tapped before. That’s likely to make Republicans re-up their demands for greater transparency.

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Republicans have pressed for detailed information on the contracts issued for Obamacare implementation and the personnel used to do the work, particularly on the botched HealthCare.gov rollout and the subsequent website salvage mission. The new report gave them exactly nothing on that score.

“In their half-hearted attempt to respond to Senate language requesting detailed Affordable Care Act expenditures, the administration refused to reveal how much was spent on specific activities and projects,” Kansas Sen. Jerry Moran, the top Republican on the appropriations subcommittee responsible for HHS, said in a statement. He said he was disappointed in the “budgetary smoke and mirrors” of the new accounting.

Rep. Michael Burgess of Texas, a top Republican on the House Energy and Commerce Committee, said the new disclosures appeared to be “more repackaging of the same kind of inadequate information we’ve gotten before.”

CMS spokesman Aaron Albright said the agency’s account of the funding for its exchange work “is consistent with the law and reported in a format consistent with precedent and other routine budget requests.”

It’s also not clear how much of a special, $1 billion Obamacare implementation fund remains, if any.

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When passed four years ago, the ACA included just $1 billion for HHS for actual implementation — an amount that advocates warned would be inadequate for legislation intended to make sweeping changes to a sector that makes up one-sixth of the U.S. economy.

The law provided vast amounts of money for the states setting up their own health insurance exchanges, but no one knew at the time that three dozen states would refuse to do that and rely on the federal exchange instead. That development turned the federal exchange into a bigger, and likely more expensive, project than it was supposed to be.

In March 2012 testimony, Sebelius said the implementation fund would likely be exhausted by the end of that year. Then, last April, federal health officials said that $235 million remained after all. She likely will be pushed on this when she starts her round of Hill testimony on the fiscal 2015 proposal next week.

The accounting table appears to show that only about $300 million of the fund would be spent by CMS through this year. But it doesn’t say how much has gone to the IRS and Department of Labor, which receive Obamacare implementation money from the same fund.

It also doesn’t say how much more money the Obama administration might pull from these funds in the future.

House Appropriations Chairman Hal Rogers (R-Ky.) specifically asked HHS to detail how much money has been put into the nonrecurring fund and how much more could still be moved there in future years, but the agency’s summary only shows how much has been pulled from the account so far.

Where will they get the money next time? The crunch won’t be as bad next year because there will be more money automatically coming in from fees on insurers — and because some of the start-up work for the health law is now complete. But the Obama administration will still have to find the rest of the money if Congress says no again — and this time, they won’t be able to turn to that prevention fund.

Under the 2014 budget agreement, the prevention fund is off limits. It will now be used entirely for the public health programs it was meant to support, mainly at the Centers for Disease Control and Prevention. That agreement satisfied both Republicans — who wanted to cut off funding sources for the law — and Harkin, who was furious that the Obama administration kept dipping into his fund to keep the law afloat.

But now, there’s a new source of money coming in: fees that HealthCare.gov has begun collecting from insurers on the federal exchange.

In 2015, when HHS is asking for $1.8 billion for Obamacare operations, those fees are expected to fund the lion’s share of the budget — $1.2 billion. But that still means the Obama administration needs Congress to cough up the other $629 million, and so far, Republicans have refused to give the law any extra money.

Sebelius said Tuesday that if Congress fails to approve the president’s request, “we will look at other sources of funding.”

What will be the Republicans’ next move? They were mostly silent on their next steps Friday, and it’s not clear that they have any good options — other than writing better letters.

Burgess said the report proves that congressional oversight will become “even more important now.” He said Congress should ask especially tough questions about the CMS account, which is needed to run the Medicare and Medicaid programs.

“That’s worrisome” if the use of the money hurts those programs, Burgess said. And if it doesn’t, and it turns out the account was overfunded, “maybe we need to look at that,” he said.

Although Republicans have challenged the Obama administration’s authority to make some of the other implementation changes they’ve made — like the various delays and extensions — they may have a harder time disputing Sebelius’s authority to move money around in her own department. Agencies are allowed to move up to 1 percent of their budgets among accounts.

And leftover funds moved to the nonrecurring expense account, while under some restrictions, can be used in any year for many one-time expenses.

Even though they’ve tried to repeal the prevention fund in the past, that’s likely off the table now that the Obama administration won’t be able to use it for implementation money anymore.

One lesson Republicans have learned from the new account is that they need to be more exacting in their requests for information, Senate aides said.

The mandate in the 2014 budget deal asked specifically for money spent on the exchanges by CMS — the lead agency — and it got precisely that, and nothing more. Omitted was any mention of $208 million spent through another HHS agency, the Health Resources and Service Administration, to fund enrollment and outreach efforts at community health centers nationwide.

The new account also provides no information on transfers to agencies outside of HHS, including to the Department of Agriculture and several others, that Republicans suspect are funding enrollment efforts.

With few other options, the main thing Republicans can do is keep asking questions, and that’s what they’ll do, according to Jennifer Hing, communications director for the House Appropriations Committee.

“The committee will continue to press HHS for information on how and where tax dollars are being spent to implement Obamacare,” she said in an email.