As Senate Minority Leader Mitch McConnell prepares to double down on the GOP’s commitment to repeal health care reform — going so far as to file an amicus brief in the ongoing multi-state lawsuit challenging the law — Democrats are sharpening their strategy to defend it.

Yesterday, during an address at the GTC BIO Conference, House and Energy Committee Charmian Henry Waxman (D-CA) highlighted the most popular consumer protections in the law, while framing the GOP strategy as an effort to take away those benefits and hand the health care system back to the insurance companies:

WAXMAN: Republicans always pose the question in terms of: Do you want to repeal “Obamacare?” They never pose these questions:

Do you want to repeal the requirement that insurers cover pre-existing conditions? That we forbid insurers from dropping coverage when you get sick? That we end lifetime limits on coverage? That we end the ability for your children to get coverage on your insurance policies through the age of 26?

And they never ask seniors:

Do you support ending the $250 subsidy those of you in the donut hole received this year, or the new 50% discount for brand name drugs you will get next year?
Do you support closing the donut hole altogether in 2020?

No, the Republicans don’t pose the questions on repeal in this manner – because they know the answers they will get from the American people.

Earlier in the speech, Waxman warned, “Last year, the Institute of Medicine issued a landmark report on the consequences of uninsurance. The report documents in exhaustive detail that a lack of health insurance coverage results in needless illness, suffering, and even death.” The comments may be part of a new offensive highlighting the costs and consequences of repeal. As The Hill’s Julian Pecquet reports, Democrats are sending around “a new report showing that 59.1 million Americans went without health insurance for at least part of the first three months of 2010 — a 400,000 increase over last year’s count from the Centers for Disease Control and Prevention (CDC).” “While GOP leaders are fighting to protect insurance companies,” the Senate Democratic Communications Center argues, “the Democrats will continue to fight to protect American families who deserve quality health care.”

Incidentally, as Ezra Klein highlighted in two charts yesterday, the individual elements of reform are in fact extremely popular and could represent the best chance for advocates to fend of the coming repeal campaign.

Earlier today, the two chairmen of the President’s Fiscal Commission — former Sen. Alan Simpson and former White House Chief of Staff Erskine Bowles — released their draft recommendations for how Congress can to achieve “nearly $4 trillion in deficit reduction through 2020″ while reducing “the deficit to 2.2% of GDP by 2015.”

On the health care side, the proposal strengthens some existing provisions in the Affordable Care Act, calling for the expansion of successful payment reforms and a far stronger Independent Payment Advisory Board (IPAB), which will advise Congress on how to control health care spending. The proposal also embraces the oft-repeated GOP idea of tort reform and throws progressives a bone by recommending that a public option be inserted into the exchanges along with an all-payer rate setting system.

Beyond this, the chairmen call for a fix to the Sustainable Growth Rate (SGR) formula that is responsible for the coming pay cuts to doctors participating in Medicare and reform in program’s cost-sharing rules. One health policy wonk I spoke to lavished particular praise on the idea of replacing “existing cost-sharing rules with universal deductibles,” describing the program’s current structure outdated and too complicated.

As TIME’s Kate Pickert points out, one of the most interesting and significant proposals is capping the tax exclusion “for employer-provided health care at the amount of the actuarial value of FEHBP standard option.” By contrast the health law establishes relatively high caps — $10,200 for individual coverage and $27,500 for family coverage — that don’t got into effect until January 1, 2018.

For longer-term savings, the chairmen recommend setting a “global target” for total federal health expenditures after 2020 (Medicare, Medicaid, CHIP, exchange subsidies, employer health exclusion),” keeping growth at GDP plus 1%.

“What I see as a problem in a lot of this is that it seems to ignore the connection between Medicare and the rest of the health care system,” the Urban Institute’s John Holahan told me, noting that he had just given the report a cursory review. “If you really try to keep Medicare down that close to GDP you’re going to have to do things to provider payments that will make Medicare unattractive.” He argued that the proposal to cap the ESI tax exclusion “helps” but said, “with the increases we’ve seen in provider concentration, it is probably necessary to do something about payment rates as well.”

These proposals are not the final report of the commission. That will require the support of 14 of the 18 members, which many consider unlikely.

A new survey of 2,800 businesses conducted by Mercer finds that employers are “not likely” to stop providing health insurance coverage “once state-run insurance exchanges become operational in 2014,” undermining the often repeated prediction that “firms will find it more attractive to stop offering insurance and let employees get coverage in the new marketplace where generous subsidies will be available. From the report:

– 6% of all large employers with 500 or more employees say they are likely to terminate their health plans and have employees seek coverage elsewhere.

– 20% of small employers (those with 10–499 employees) say they are likely to terminate their health plans, especially those with low-paid workers and high turnover, like retailers.

Look:

While small employers are more likely to drop coverage than larger companies — companies that are too small to spread the risk and cost of coverage across a large pool of beneficiaries are often vulnerable to premium increases if just one employee falls gravely ill — Tracy Watts, a Partner in Mercer’s Washington, DC, office suggests that for most large companies offering insurance is a way to maintain control over what they spend on health care. “Employers are reluctant to lose control over a key employee benefit,” she said. “But beyond that, once you consider the penalty, the loss of tax savings and grossing up employee income so they can purchase comparable coverage through an exchange, for many employers dropping coverage may not equate to savings.”

After the first 10 years, the Congressional Budget Office estimates that “the number of people obtaining coverage through their employer would be about 3 million lower in 2019 under the legislation.” Actuaries at CMS estimated that just 1.4 million would move out of employer coverage.

Large employers also wouldn’t have access to the exchanges until 2017. And even then, it will be up to the states to allow large employers into the new marketplace. Of course, the gradual shift from ESI (employer sponsored insurance) to regulated individual policies is not necessarily a bad thing (the fear has always been that this would happen too quickly and cause severe coverage disruption). And this study simply confirms that the law accomplishes all this very, very slowly.

Back in May, Senator-elect Rand Paul (R-KY) raised more than a few eyebrows when he backed Democratic efforts to prevent cuts to physician payments under a program called the sustained growth rate, or SGR. At one campaign event Paul, an ophthalmologist who generated 50 percent of his practice from government reimbursements, said, “Physicians should be allowed to make a comfortable living,” conveniently disregarding his pledge to institute “across the board cuts” on government spending.

Well, last night, CNN’s Eliot Spitzer took Paul to task on this apparent contradiction, asking the newly minted lawmaker about why he was excluding his former colleagues from the gruesome cuts — particularly since Medicare spending was primarily responsible for the growing deficit. Remarkably, Paul immediately backed away from his broad-brush indictment of government spending and argued that cutting reimbursements would reduce access to physicians:

SPITZER: You’ve said that the one place you don’t want to cut is doctor reimbursement rates?

PAUL: You’ve been reading too many liberal bloggers. Let me set you straight…What I have said is that look, if we want to cut physician fees automatically without a vote, let’s lump all federal employees in there, senators, congressmen and all two million federal employees and let’s all automatically cut their pay every year without a vote and I’m all for it. But right now, let’s not single out one set of people and say that somehow we’re going to balance the health care budget on one set of people. The problem is that ultimately if you keep reducing. For example, if physician fees go down in Medicare by 30 percent as they’re designated to do in December, you won’t find a doctor. I think we need to think about do we want to have doctors available to see patients and I think that’s a major problem.

SPITZER: But Senator, I’m correct in saying you’ve opposed cutting Medicare reimbursement rates even though the Medicare system is the single largest deficit hole we’re facing as we look at our budget and reimbursing doctors is the largest piece of that.

PAUL: You do have to figure out how to balance the Medicare budget and it’s going to take a lot of different things to do it, but you can’t balance it simply on one facet.

Watch it:

From there, the interview deteriorated into a painfully uncomfortable and at times personal exchange. Spitzer pressed Paul on his “peak income over the past decade,” to which the Senator dryly shot back, “do I want to go back to your personal past and talk about your past on this program? I don’t think so.”

Spitzer proceeded to ask Paul to name specific programs he would cut from health care, Social Security or defense. But Paul, demurred, explaining that he would offer a balanced budget in the next Congress — over 1, 2, 3, 4 and 5 year increments, but was still unsure of what to cut to get there. At one point, Paul even suggested that rather than pressing him for specifics, Spitzer should invite liberals and ask “how do you continue to have these programs?”

Paul went on to chastise lawmakers for breaking certain budget and spending rules. “The main thing you have to have is you have to have rules [to balance the budget],” and make “difficult decisions” he said, unaware that by reversing the physician cuts under SGR he would be, in fact, breaking a spending rule. “Nothing is off limits,” he said. “We will look at each individual program and we will do a stepwise process to this. We will say, can it be downsized, can it be privatized, can it be eliminated or can we not look at this program at all because it’s too important and it can’t be cut.” He offered no specifics last night, however.

Pushed to the edge by Spitzer, Paul did rattle off ideas like repealing the health care law and sending back TARP dollars, before telling Spitzer that his “personal agenda is getting in the way of making you a very good broadcaster” and claiming he had to leave for another interview. Spitzer responded curtly. “Sir, the tenor of the campaign in which you say you’re going to balance the budget and cannot name a single cut suggests to me that that debases politics,” he said and ended the segment.

Incidentally, Paul is in complete agreement with the administration and the doctor’s lobby on the reimbursement issue. In a speech to the Association of American Medical Colleges, HHS Secretary Kathleen Sebelius “pushed for an extension to the so-called doc fix to stop an expected 23% cut to Medicare payments for physicians,” saying “I hope that Congress will act quickly to pass it, so that our doctors and seniors can have some peace of mind while we work on a long-term fix.”