Officials have not said how sequestration would affect the health care law. Spared from the ax: Obamacare?

The Obama administration has issued ample warnings how the sequester can have dire effects on health programs.

Official talk about fewer vaccines, cuts in medical research grants, less money to treat HIV, fund cancer screenings or respond to outbreaks.


But they haven’t been issuing a lot of warnings about how it’s slowing down the rollout of Obamacare.

Because sequester or no sequester, the administration is trying to keep work on the core elements full steam ahead.

The Department of Health and Human Services wouldn’t respond to questions about the automatic budget cuts and health law implementation. But both advocates and critics of the law expect HHS to use all the flexibility it can muster to keep it moving — although it could get harder if the sequestration is prolonged.

“I’ll put it this way: When they talk about dogs and cats sleeping together, the hell-on-earth consequences of the sequester taking effect, one of the things they have not mentioned is that they won’t be able to implement the [health law],” said Tevi Troy, former deputy secretary of HHS under President George W. Bush.

The administration may complain about the bluntness of across-the-board cuts, but when it comes to Obamacare, it “will move heaven and earth” to get it done, Troy predicted.

That may mean sacrificing some other priorities to the cause of pushing the health law across the finish line. It includes continuing to cobble together money to finish the federal exchange, which got no explicit funding of its own in the health care law and is far more costly than initially envisioned because HHS has to build them in 25 states, way more than anticipated.

But while friends and foes of Obamacare are confident that the administration will be able to move forward, they know it’s going to get harder.

“Both for reasons of historical judgment and the plain and simple importance of giving this law the best possible shot at succeeding, I believe that money and staff will be found,” Henry Aaron, senior fellow at the Brookings Institution, wrote in an email to POLITICO. “If somebody has to be pulled off another task, they will be. If another contract has to be delayed, it will be.”

Key parts of the health law are exempt from the sequester, notably the money to subsidize insurance for eligible people and the Medicaid expansion. Those don’t start until 2014 anyway. But other administrative aspects, including set-up funds, are affected.

An effective 9 percent cut over the next seven months would seem to be cause for concern for Obamacare advocates when federal health officials are all hands on deck trying to get key pieces of the law in place. The exchanges are supposed to open for enrollment this fall and begin distributing premium subsidies next year.

Ron Pollack, executive director of Families USA, said the sequester does pose problems, especially for the badly needed public outreach campaign beginning this summer to educate a population about Obamacare and help people enroll.

“It puts an even greater onus on private-sector efforts to reach out to people and educate them,” he said.

The successor of Obama’s campaign, Organizing for Action, and Enroll America, a diverse collection of the reform law supporters, are planning a major campaign that could pick up the slack.

But Pollack is confident that when it comes to the infrastructure for the federal exchange and the data hub that will help determine what type of coverage — and subsidies — applicants can get, HHS will find the resources somehow.

“Those things are of such high priority that they will move forward,” Pollack said.

But where exactly will the money come from?

“It’s not entirely clear,” said Edwin Park, vice president of health policy at the Center on Budget and Policy Priorities. “The sequester will strain the agency’s resources,” he said, but “there is a confidence” that the crucial components will remain on track.

The administration’s budget request last year called for an additional $864 million in one-time funding to finish building the federal exchange. And HHS Secretary Kathleen Sebelius testified in budget hearings then that the $1 billion provided in the Affordable Care Act for federal implementation of the law would be spent by the end of 2012.

By contrast, the law supplied HHS with ample funding to send to states that would set up their own exchanges. California alone has received more than $910 million in exchange grants, for instance.

But HHS didn’t get another dime for its work. The continuing resolution that is funding the government through March 27 froze funding at 2012 levels. HHS is not going to get a raise and will almost certainly be targeted — successfully or not — for cuts when Congress takes up government funding again in March. Most HHS funds that can be tapped for the health law will be subject to the sequester unless it is dealt with by then.

HHS did not respond to questions about whether any of the original $1 billion for implementation remains.

Troy, the former deputy secretary of HHS, suggests one possibility for funding. He said agencies are typically allowed to move about 1 percent of their budgets around accounts as needed and that ability is not affected by the sequester. That would be about $750 million at HHS, he said.

But the political reality is that every agency constituency will be pressing HHS to use any flexibility it has in their favor, said Douglas Holtz-Eakin, former Congressional Budget Office director under Bush.

“It’s not like you could take all $750 million and stick it on Obamacare,” he said, adding that flexibility is typically diminished when applied to a controversial policy.

“I have no doubt they will use any funds they can to implement the law … but the sequester can’t be helping,” he said.