On December 14, former Secretary of the Department of Health and Human Services Kathleen Sebelius made news by calling the decisions of Kansas and Missouri to turn down the Medicaid expansion contained in the Affordable Care Act “morally repugnant and economically stupid.”

Heated political rhetoric does not alter the fact that a state’s decision to expand Medicaid involves complicated tradeoffs.

The Senate voted overwhelmingly today 65-33 in favor a $1.8 trillion package of spending bills and tax breaks, sending the legislation to President Obama’s desk for his signature. Included in the two bills are provisions trimming some of the levies that help finance ObamaCare. A tax on medical devices would be suspended for two years, a levy on health insurers would stop for a year and a tax on higher-cost insurance policies would be postponed two years until 2020.

It has been called into question whether it’s true that Sen. Marco Rubio is responsible for the provision (inserted into last year’s annual spending bill and now again into this year’s) that requires the risk-corridor program in ObamaCare to be budget neutral. Like this year’s giant spending law, last year’s omnibus bill was the result of a leadership-driven process that drew on substantive expertise from the relevant committee staffs but did not much involve most members of either house. But Rubio was without question the first and most significant congressional voice on this subject, and if he hadn’t done the work he did, the risk-corridor neutralization provision would not have been in last year’s (or this year’s) budget bill.

In a big package of tax and spending legislation that Congress is likely to approve this week, Republicans have forced President Obama to swallow three changes that undermine his signature health care law, including a two-year delay of a tax on high-cost insurance plans provided by employers to workers.

In an interview on Wednesday, Mr. Obama’s first budget director, Peter R. Orszag, a leading supporter of the Cadillac tax, said, “The two-year delay is likely to be equivalent to repeal of the tax because people will expect it to be deferred again and again.”

The Cadillac tax contained in the Affordable Care Act represented an attempt to remedy a major problem with health care and tax policy – the exclusion of the cost of employer-sponsored insurance from both income and payroll taxes. Regardless of political leanings, economists generally agree that the exclusion causes employers to offer overly expansive insurance. This depresses wages and increases overall health care spending. Moreover, the exclusion provides a disproportionate benefit to the wealthy.

It goes without saying that delaying a scheduled tax increase is a tax cut. According to the Joint Committee on Taxation, a two year delay of the Cadillac tax combined with deductibility will save taxpayers $20 billion over the next decade. Conservatives are for tax relief.

Conservatives are for repealing ObamaCare, in whole or in part. The Cadillac Plan excise tax is a part of how ObamaCare’s latticework of subsidies and regulations is supported. Delaying on the road to repealing parts of the ObamaCare law is good public policy. Eventually, we want to repeal and replace all of ObamaCare.

Health insurers nabbed a victory in the $1 trillion spending bill unveiled late Tuesday night, earning a one-year freeze on the so-called premium tax. The tax has been strongly opposed by insurance companies and business groups, who argue that the cost of the tax is passed on to workers in the form of higher premiums.

There has been some interesting coverage lately about Florida Sen. Marco Rubio’s successful effort to ensure that taxpayers were not on the hook for excess losses incurred by insurers participating in Obamacare’s exchanges. Today, however, two Associated Press reporters alleged that this victory against the law was one that Rubio “didn’t deliver.” But the facts show that Rubio is right, and the AP is wrong.

The House reached a deal late Tuesday on a $1.1 trillion spending bill and a huge package of tax breaks. Throughout Tuesday, major components of the spending legislation appeared to be falling into place, including an agreement to alter major provisions of the Affordable Care Act, delaying a planned tax on high-cost health insurance plans and suspending a tax on medical devices for two years. Lawmakers also agreed to delay the Cadillac tax on high-cost employer-sponsored health plans by two years, originally scheduled to take effect in 2018.

Consumers anxious to beat the midnight Tuesday deadline to enroll on the federal insurance exchange overwhelmed call center lines Monday, federal officials said. Some people were being asked to leave their names so they could be called back after the deadline to be enrolled. The Centers for Medicare and Medicaid Services said they would still be able to have coverage effective Jan. 1 if they left their contact information before the deadline.