Before the ink of his signature dried on March 23, 2010, Republicans' sole focus in health care policy has been to repeal President Obama's signature legislative achievement. The Affordable Care Act did not come easy. It had the steepest uphill climb, cost by far the most political capital, and had moments where its fate was uncertain. When Republicans failed to block its passage in Congress, their next step was to attempt to repeal it in every way possible. And if it couldn't be repealed, they vowed to make its implementation as difficult as possible.
The 37 attempts at repeal were legislative. There was just one problem: math. They didn't have the votes. Republicans won the House in 2010, but Democrats kept the Senate. The only legislative body that could realistically pass repeal is the House, because in the Senate they had nowhere near the 60 votes required to invoke cloture, or even a simple majority to repeal parts via Reconciliation, much less 67 votes to override an inevitable presidential veto. These repeal votes were purely symbolic. It was so freshmen representatives could tell their constituents that they personally voted to repeal Obamacare, despite taking that vote 37 times being a monumental waste of time.
The next option was a judicial repeal. In June of last year the Affordable Care Act walked out of the Supreme Court alive and largely intact. Now it was back to the old fashion way: get someone in the White House who would sign a repeal, and get enough votes in both chambers of Congress to pass a repeal bill. Once again, that effort failed miserably. President Obama was reelected by a comfortable margin and Democrats picked up aggregate seats in the House and Senate. Effectively, all routes to repeal were now closed.
Republicans were left with two options. One is they could accept implementation as a matter of fact, and work with the administration's implementation in an effort to put their own twist on the law and reform it in their favor as much as possible. The second option was to continue to showboat symbolic repeal votes and do everything they can to make implementation as difficult as possible. Congress and some governors have always stuck with the latter, where the proposed repeal of Obamacare has been their sole contribution to the national discussion on health care reform, though many Republican governors who oppose the ACA have now signed on for the Medicaid expansion, seeing that being able to put their own twist on implementation is much more preferable.
Congressional Republicans' probe of HHS Secretary Kathleen Sebelius over fundraising for Enroll America — a 501c3 designed to promote and ease the implementation of the Affordable Care Act — is another example of trying to make implementation as big of a headache as possible. With a law as big and consequential as the Affordable Care Act, it is very important that everyone knows what exactly is going on in terms of implementation. Providers need to be up to speed and those who stand to benefit from the law (the uninsured) need to know how exactly to go about enrolling on one of their new plans that are provided. Enroll America takes donations from the major players at the table who have the most at stake in making sure the ACA's implementation is as smooth as possible, mainly providers. The same method was used in the implementation of Medicare Part D and the Children’s Health Insurance Program in the past.
This is also especially important given the volume of misinformation floating around the ACA. Four in 10 Americans are not even sure if it is still in fact the law of the land, and blatantly lying about what the ACA is and does has been a political strategy since long before it even became law.
The ultimate irony in all of this is there were actually funds originally appropriated for an enrollment education strategy that Enroll America pursues, but that funding was blocked by Congress, forcing private fundraising as the go-to strategy in this aspect of implementation. What Congress is really upset about now is this is private money they can't control, as reflected in Senator Lamar Alexander's (R-Tenn.) comments when he said the administration is "undercutting the congressional power of the purse by circuitously exceeding the amount Congress has appropriated."