Health care reform may not have enough votes to pass Congress, but state lawmakers are pushing ahead with constitutional challenges to the individual health insurance mandate. Yesterday, a committee in the Kansas House of Representatives approved, a “ballot measure that would invalidate any laws that mandate individuals “to participate in any health care system or purchase health insurance.”

“A person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines for paying directly for lawful health care services,” the legislation says:

‘Explanatory statement. The purpose of this health care freedom amendment is to preserve constitutionally the right and freedom of Kansans to provide for their health care.…Nothing in this amendment is meant to discourage anyone from purchasing health insurance

The measure will now go to the full House. “It would need two-thirds approval there and in the Senate before being added to a statewide ballot to be decided by voters. An identical measure was passed without recommendation earlier this session by the Senate Public Health and Welfare Committee but remains lodged in the Senate Judiciary Committee.”

Legislatures in approximately 30 states have introduced similar initiatives and Congressional Republicans have pledged to support their efforts, promising to “spend the rest of the year in the campaign to try to repeal.” But these campaigns to repeal reform are more about energizing the base and raising campaign funds than registering a serious policy disagreement. Republicans had supported the individual health insurance mandate as recently as August 2009, and any successful state measure to repeal the mandate will be superceded by federal legislation.

On a policy note, the reason for including an individual mandate is fairly straight forward. The individual mandate creates incentives for otherwise healthy Americans to purchase insurance and may be the the only way to achieve affordable universal coverage. Without a mandate, only the sick who need health care would be motivated to purchase it. The pool of insured would be weighted with sick individuals, forcing the costs of the premium to escalate.

President Obama has once again delivered a timeframe by which he would like to see Congress pass health reform, telling lawmakers that reform deserves an up or down vote “in the next few weeks.” Last year, Obama had asked Congress to deliver reform by August and then before the end of 2009, but his words did little to sway reluctant Democrats. This time, Obama again urged Congress to “get this done” without setting a firm deadline.

In today’s speech, Obama detailed Democrats’ efforts to reach out to Republicans on reform and characterized the final legislation as a bipartisan proposal that incorporates Republican ideas. “It incorporates the best ideas from Democrats and Republicans – including some of the ideas that Republicans offered during the health care summit, like funding state grants on medical malpractice reform and curbing waste, fraud, and abuse in the health care system,” Obama stressed.

The president stopped short of officially endorsing the reconciliation mechanism but fully committed himself to shepherding reform though the final stages of the legislative process:

We have debated this issue thoroughly, not just for a year, but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of sixty votes. And now it deserves the same kind of up-or-down vote that was cast on welfare reform, the Children’s Health Insurance Program, COBRA health coverage for the unemployed, and both Bush tax cuts – all of which had to pass Congress with nothing more than a simple majority.

I have therefore asked leaders in both of Houses of Congress to finish their work and schedule a vote in the next few weeks. From now until then, I will do everything in my power to make the case for reform. And I urge every American who wants this reform to make their voice heard as well – every family, every business owner, every patient, every doctor, every nurse.

Obama positioned his plan as the middle of two ideological extremes. It’s a tactic he employed during the campaign, but his administration has spent little time explaining the more conservative ideas in the Democrats’ health care bills or stressing the GOP’s past support for large sections of “Obamacare.” The President returned to this frame today, saying, “On one end of the spectrum, there are some who have suggested scrapping our system of private insurance and replacing it with government-run health care…On the other end of the spectrum, there are those, including most Republicans in Congress, who believe the answer is to loosen regulations on the insurance industry.” “I disagree with that approach.”

On the process side, the President finally said what many progressives had urged him to say in the aftermath of the Massachusetts election: he took incremental reform off the table and laid out a roadmap for passing comprehensive reform in the near future (although some can certainly argue that the timeline was not detailed enough). Whether or not he acted too late, however, will have less to do with Obama and more to do with reluctant House members.

During a speech on the Senate floor this afternoon, Sen. John McCain (R-AZ) rejected President Obama’s offer to remove the so-called Florida special deal from the health care bill and urged Democrats to start over and scrap all other “special deals” from the legislation. At one point, McCain even mocked Majority Leader Harry Reid’s claim that treating states differently is “what legislation is all about.” “Why would a state be treated differently from another state? Why would we have disparate impact on different states?” he asked:

MCCAIN: My friends, that’s not compromise. That’s not the right word. Compromise is an agreement between two parties on both sides of the aisle that reach an agreement. What this is is back room wheeler dealing, special interests influence and vote buying. That’s what this was… Why should it ever happen that the residents of one state that are in the same program, exact same federal program, have different advantages over another state?

Watch it:

The answer to McCain’s question is rather simple. Different states have different needs and prudent federal policies often considers each state’s unique economic conditions and circumstances in crafting legislation. For example, the federal matching formula for Medicaid varies from state to state, depending on each state’s poverty level. Treating all states equally would overcompensate richer states and severely undermine poorer states that don’t have the tax base or resources to adequately fund federal programs. Poorer states are also more likely to struggle with higher health care costs, less healthy populations, and citizens who can’t afford private health insurance.

McCain concluded his speech with a remark that would surely make his former running mate happy, saying “unless we start over, then how in the world can we put lipstick on a pig? It’s still a pig. It is still a bad and unsavory process that we went through in order to reach the legislative package we have now.” In fact, McCain may have even been echoing Palin who also criticized Democrats for “putting ‘perfume on a pig.‘”

Mitt Romney appeared on Morning Joe this morning to promote his new book “No Apology,” in which he argues that America must stop making excuses for its mistakes and begin solving its national problems. “We’ve got to stop apologizing to ourselves for lousy schools, for not having dealt with our entitlement problems, for spending too much money,” Romney said, suggesting that the government will have to cut Medicare spending.

But when asked about national health care reform, Romney criticized Democrats for tackling the entitlement problem. “There were big differences between what we did [in Massachusetts] and what’s going on in Washington,” Romney said. “We said we’re not going to raise taxes. We have to do this within our current budget and finally, we’re not going to cut Medicare as a means to do it.” Joe Scarborough pressed Romney on the contradiction:

SCARBOROUGH: Let me ask you, though. You say you’re not going to cut Medicare, and Republicans have been critical of the proposed cuts in Medicare. But you said off the top, we have to face our entitlement crisis. There is no greater crisis than the threat to Medicare. Will you admit right now to America that if Medicare is going to exist after 2019, we’re going to have to cut Medicare?

ROMNEY: Look, there is no question about that. The way the president’s health care plan works, he says we’ll take $500 billion out of Medicare Advantage. Wait a second. Let’s talk about a better approach than just slashing a portion of the program.

Watch it:

In truth, the Senate health care plan only cuts about $120 billion from Medicare Advantage over 10 years; the rest of the money is coming from payment updates and other efficiencies in the Medicare system. The bills reduce payments to Medicare Advantage (which receive payments that are on average 19% higher than traditional Medicare) because, on the whole, the overpayments are actually shortening the life of the Medicare trust fund without improving health outcomes. According to the Congressional Budget Office, the Senate bill’s Medicare cuts would extend the life of the Medicare program and lower spending per Medicare beneficiary from 8% growth rate to 6% growth rate.

Romney, unfortunately, wants to have it both ways. He sternly warns Congress that “unless we deal with the entitlement burden which is $60 trillion, unfunded liability, America’s future could be very bleak for our grandkids,” but then criticizes Democrats for proposing policies that reduce the government’s entitlement spending.