This morning, Rep. Dave Reichert (R-WA) aggressively pressed Health and Human Services Secretary Kathleen Sebelius on whether the Affordable Care Act would allow individuals to keep the coverage they have if they like it and argued that HHS regulations would lead Americans to lose their current plans:

REICHERT: Do you still believe that statement? In this bill you’re able to keep your health care plan and your doctor if you like it. Is that an accurate statement? Just a yes or no?

SEBELIUS: Congressman, it’s accurate to the point that we are not tampering with the existing system. Employers make choices of plan changes and doctor changes that right now, employers don’t control.

REICHERT: Madam Secretary, please. My time is limited. Here is the problem, people in America just want to know. [...]

SEBELIUS: Employers choose care for 180 million Americans…

REICHERT: Madam Secretary, please. If the President said there is language in the bill that runs contrary to that promise…will you work to change the language in the bill to insure that the American people can keep their doctor and keep their health plan.

SEBELIUS: Congressman, I would be happy to work with you on that. But as you know, we don’t order doctors to take Medicare patients…or take Medicaid patients. We don’t order employers to keep the same the same plan with the same network. That has never been part of the promise.

Watch it:

The problem with President Obama’s statement that “if you like the coverage you have you can keep it” is that it lends itself to a very literal interpretation — the suggestion that health care plans won’t change, rather than the correct interpretation that health reform won’t force you to enroll in a new plan (so long as your existing plan offers comprehensive benefits).

The administration hopes to allow consumers to keep their existing plan, while also ensuring that there are some basic patient protections built into these plans. Last year, HHS unveiled regulations to exempt health insurance plans in existence before March 23, 2010 — the day the Affordable Care Act became law — from many of the new regulations, benefits standards and consumer protections that new plans now have to abide by. But the exclusion comes with conditions. If the plans or employers make changes that undermine the spirit of the health law and significantly burden enrollees with lower benefits and increased costs, they have to come into compliance with all the consumer protections. (In November of last year, HHS loosened the regulations to help employers hang on to their grandfather protections longer.)

HHS estimates that a good percentage of small business plans and policies in the individual market will lose their grandfather status and look for cheaper coverage that already meets the new requirements. And that’s a good thing. The grandfather regulations serve as a bridge to gradually move everyone into plans that have the kind of consumer protections that Americans say they want. By 2014 almost all plans will be in full compliance.

In the same way that the government requires automakers to meet certain safety standards and design specifications, insurance issuers and employers will have to abide by new benefit and consumer protection minimums. They shield consumers from drastic benefit cuts or cost shifts. And by discouraging insurers and employers from making these changes, the regulations in the law help you like what you have rather than just being stuck with your existing plan.

In testimony before the House Judiciary Committee today, former acting Solicitor General Walter Dellinger predicted not only that the Supreme Court will reject the meritless lawsuits challenging the Affordable Care Act, but also that the opinion will be written by conservative Chief Justice John Roberts:

I would wager that Chief Justice Roberts writes the opinion upholding the law. . . . He won’t want to say that the market alternatives are ruled out and you can only use monolithic government alternatives, he’s going to write an opinion to say that this is upheld—not because Congress can use its commerce power to impose affirmative obligations willy nilly to purchase products—but it [will be] upheld because of all the reasons we’ve said about the central role it plays in avoiding the displacement of costs onto other citizens.

Watch it:

As Dellinger points out, the lawsuits attacking the ACA do not question that Congress has the power to create entirely-government run health programs such as Medicare, so a Supreme Court decision striking down President Obama’s key accomplishment would have the strange result of requiring national leaders to reform the health system without allowing them to rely on this exclusively market-driven solution. That seems like a odd line for a corporate conservative like Roberts to draw.

Moreover, Roberts has shown little appetite for the radical vision of states rights which drives the challenges to health reform. In the Court’s most important federalism decision since he joined the Court, United States v. Comstock, Roberts joined the Court’s four moderates in refusing to roll back Congress’ power to ensure that federal laws function effectively. Roberts is also perfectly aware of the fact that radical states rights doctrines cut both ways, and many of the same tenther arguments that would kill progressives’ ability to fix the U.S. health system would also cut back on Roberts and other conservatives’ power to give corporations broad immunity from state law.

There are, of course, no good legal arguments against the Affordable Care Act. As Adam Serwer points out, however, there are political arguments against it. In a post Bush v. Gore era, there is always the risk that Roberts and his fellow conservatives will simply ignore everything that has come before them and dream up some tortured reason to strike down the law.

But there is good reason to believe that a purely cynical John Roberts would vote to uphold the ACA entirely because it will enhance his power to do the right-wing’s bidding. Most political commentators do not distinguish between corporate conservatives such as Roberts and tenther conservatives such as Justice Thomas, even though the two justices sometimes wind up on opposite sides of major constitutional cases. So if Roberts were to reject the ridiculous legal arguments against the ACA, such a vote would immediately be held up as proof that the Court is not the kneejerk servant of wealthy interest groups that Roberts has fought so hard to transform it into.

For years after Roberts did nothing more than turn his back on legal claims that border on frivolous, his corporate backers could cite his Affordable Care Act decision as proof that he is an honest and non-ideological judge. Roberts would then eagerly wield this political cover to enact the one agenda he cares most about — shielding powerful corporations from the law.

In a memo to House Republicans marked “confidential”, the Tea Party group FreedomWorks praises the GOP for passing health care repeal legislation in the House, but argues that the party must now turn its attention on the ‘repeal’ part of its agenda to build greater support for rescinding the law. In a reversal of past strategy which urged members to hold votes on specific provisions of the law, the Dick Armey-led group is now asking Republicans to “improve” the law “so long as the improvements don’t significantly increase its support.” Similarly, the group warns the GOP against collaborating with health care groups to eliminate that IPAB board or other provisions “unless the affected industries endorse full repeal.” A more effective strategy is to “Highlight the special interest deals and corrupt bargains. Scrutinize the hundreds of waivers and thousands of pages of regulations issuing from HHS. Publicize the premium cost increases and coverage losses. Keep Dr. Berwick talking,” the memo says.

Republicans should reject some of the most popular elements of reform and offer legislation that embraces the existing individual market, Armey writes. He dismisses reforms like “the unnecessary small-business tax credits” and describes caps on annual limits, the ban on lifetime limits, the adult children coverage provision, and the caps on insurance company profits as “cost insurance mandates.” The memo argues that “[b]anning preex condition clauses is counterproductive, because it raises premiums and causes coverage to be dropped.” “It’s also unnecessary because federal and state laws already offer significant protections,” it says, ignoring the fact that more than 40 states and the District of Columbia don’t have laws protecting individuals with pre-existing conditions from being denied coverage.

Instead, Republicans must focus on expanding the unregulated individual health insurance market, without paying too much attention to “how many people are covered,” the memo states. It also encourages the GOP to embrace the health care portions of Rep. Paul Ryan’s (R-WI) Roadmap:

True insurance, which exists to help people pool risks, should be kept distinct in our minds from group “insurance,” which is really a form of pre-paid benefits. With true (individual) insurance, prices need to vary according to risk and purchasers need to plan ahead. You can’t buy fire insurance after your house has burned down. By contrast, pre-paid benefits are generally open to everyone in the group (guaranteed issue) and the price is the same for everyone, regardless of the amount of risk each person brings to the plan (community rating). Many states and Obamacare try to regulate true insurance as if it were pre-paid benefits. That’s misguided in the extreme. When government does that, it merely drives up the costs of the insurance or causes it to become unavailable. Therefore, we should always favor policies that lower the costs of true insurance and increase the number of people who can obtain it. We should grow the individual market.

Not only will this replacement legislation face overwhelming public opposition — polls have consistently shown that Americans approve of the consumer protection provisions in the law — but it would also take away the means by which individuals with chronic conditions can find affordable insurance. FreedomWorks suggests that the 129 million Americans with pre-existing conditions should purchase insurance in state-based high-risk pools, but existing pools have failed to attract enough beneficiaries because the cost of covering large groups of sick individuals is simply too great.

FreedomWorks’ solution to transform Medicare into a voucher program and give states block grants to fund Medicaid, would similarly devastate access to coverage. Under the voucher scheme, seniors would have to pay more for comparable coverage, while states received Medicaid block grants — a fixed dollar amount annually that would fall below current growth — would either have to (as the CBO put it) “provide less extensive coverage or to pay a larger share of the program’s total costs.”

Read the full memo HERE.

This morning, Rep. Jim McDermott (D-WA) asked Health and Human Services Secretary Kathleen Sebelius what would happen to seniors if Congress adopted Rep. Paul Ryan’s (R-WI) Roadmap proposal, which privatizes Medicare for incoming seniors. Under Ryan’s plan, new Medicare enrollees would receive an annual voucher they could use to purchase health insurance beginning in 2021. The voucher would initially be worth an average of $5,900 (in 2010 dollars) and increase to an average of $11,000 in 2010 dollars once all age-groups are phased in.

Sebelius rejected the plan, arguing that the government was responsible for ensuring the longevity of the Medicare program and that seniors who try to purchase individual coverage with vouchers would have limited leverage against large insurers. People in the individual market “are often penalized,” she said. “They pay 18 to 20 percent more than those who are in large employer pools. One of the reason for the health exchanges is to help pull people into pools so they have some purchasing power.” Sebelius also speculated she could not imagine her 90 year old father self-purchasing insurance. Watch it:

Yesterday, my colleagues Karen Davenport and Isabel Perera released a new report arguing that Ryan’s voucher system would also force seniors to pay more for care, since the plan saves money by offering a voucher that does not keep up with health care costs:

Under current law, people with Medicare coverage can expect to pay $2,730 per year ($228 a month) in 2021 for total Part B and Part D premiums, which will provide them with full Medicare benefits. Under Rep. Ryan’s proposal, new Medicare enrollees will pay an average of $3,579 for equivalent coverage—a 31 percent increase in their premium for this year. This “Roadmap” premium increase will grow over time, as the voucher’s value fails to keep up with increases in health care costs.

Indeed, the Ryan plan will mean that seniors and people with disabilities who receive the “Roadmap” voucher would face an average increase in premiums of almost $850 in 2021, which will grow to nearly $1,060 in 2025, to purchase a benefit package equivalent to today’s Medicare program.

Look:

Significantly, the Congressional Budget Office agrees with this assessment. “Voucher recipients would probably have to purchase less extensive coverage or pay higher premiums than they would under current law,” the CBO found, noting that “the federal government would pay [less] for enrollees on a per capita basis, relative to the projections under current law” and “future beneficiaries would probably face higher premiums in the private market for a package of benefits similar to that currently provided by Medicare.”

Republicans who promised to listen “to the people who sent us here” following the midterm elections will now find themselves acting against public opinion as they seek to defund the Affordable Care Act. That’s because a new CBS News poll finds that a majority disapprove of underfunding the law and “and many aren’t sure of its impact on the health care system”:

Most Americans, 55 percent, disapprove of the plan to cut off funding to the new health care reforms, and just 35 percent approve. Among Republicans, approval rises to 57 percent. Forty-nine percent of independents disapprove, and 38 percent approve.

Overall, Americans are wary of the new health care reform laws: 21 percent think the new law will make the system better, but 23 percent think the law will make the system worse. Another 44 percent say they don’t know enough to say what the law’s impact will be. Uncertainty has increased since the law was first passed last year.

And while there are partisan differences – 43 percent of Republicans think it will make the system worse, but 40 percent of Democrats see it as an improvement – large segments of Republicans, Democrats and independents don’t know what effect the law will have on the health care system.

As has been the case since the law was passed nearly a year ago, more Americans disapprove than approve of the legislation. Now, 33 percent approve, while 51 percent disapprove, including 34 percent who disapprove strongly.

Look:

But Republicans — who have pledged to press ahead with unraveling reform — have already dispensed with their pledge to listen to the people. During his speech at CPAC yesterday, Senate Minority Leader Mitch McConnell (R-KY) promised to push ahead with repealing the Affordable Care Act in the Senate, despite a failed party-line vote. “We’re not about to retreat,” McConnell said, insisting that Republicans were “just getting started” in their campaign to rescind the law. “When we started this debate, the president’s vision of reform had the support of about 70 percent of the American people. But here’s the problem: We didn’t swear an oath to uphold whatever’s popular. We swore an oath to uphold the Constitution,” McConnell said, referring to a recent court ruling which found the law to be unconstitutional.

In November, however, the GOP leader promised that “Republicans have a plan for following through on the wishes of the American people.” “And, above all, it means listening to the people who sent us here,” he said.